The Affordable Care Act brings significant changes to the delivery of and access to health care. It is the biggest overhaul of the U.S. health insurance industry since the Medicare and Medicaid programs were created in 1965, improving health-care access for millions of uninsured Americans by expanding Medicaid, extending dependent coverage to young adults, and eliminating exclusions from coverage on the basis of preexisting conditions. However, the resulting increase in the nation's insured population will also place greater demands on health-care providers, especially primary-care physicians.
One central tenet of the act is that the health-care system needs to move from paying for services to paying for value. The law attempts to achieve this goal through several innovative efforts to encourage care coordination and efficiency, including bundled payments and accountable care organizations. These efforts will help us learn how to provide better care at lower costs.
In hindsight, the Obama administration and Democratic Congress of 2009 could have met their policy objectives by modifying some of the Bush administration's significant policy initiatives, especially the Medicare Modernization Act of 2003, which added drug coverage and managed-care plans to Medicare. Both supporters and critics of Medicare's managed-care programs subsequently learned what they did well and where they needed to be modified. The Obama administration could have used that knowledge to keep expanding Medicare, a program supported by most Americans, while adjusting it to meet the current needs of the population.
However, since the 2008 election, health-care policy has been a matter of national partisan politics. Much the same has happened in Britain, where Tony Blair and the Labor Party won elections in 1997 promising to reverse the policies of Margaret Thatcher's Conservative Party; and in 2010, David Cameron's Conservative Party was elected pledging to reverse the changes brought about by the Labor Party. Such major and repeated shifts in health-care policy do not help those who use, provide, or pay for medical care; the health-care system is too complex to hit such moving targets.
Regardless of who wins the presidency in the fall, the route to long-term improvement of health care in this country is not another major shift in the direction taken by the Affordable Care Act. The law has already provided a road map for change, and we stand to learn much from the innovative efforts it prescribes. Despite the current campaign rhetoric, Mitt Romney well knows the advantages of the act's approach from his experience initiating Massachusetts' health-care reform, which was the model for the Affordable Care Act.
It would be best to continue efforts to improve and expand health care in this country through our system of private hospitals, doctors, and insurance companies, paid for by a mix of private- and public-sector entities. That combination of public- and private-sector financing, with private-sector delivery of services, has worked for Americans since 1965, and it should be allowed to keep running its course through the implementation of the Affordable Care Act.
Ralph W. Muller is chief executive officer of the University of Pennsylvania Health System.
