‘A’ for access: Health leaders warn that despite reform, uncertainty abounds
As it nears the takeoff point, Obamacare gets an “A” for increased access but just average grades for implementation, so far.
That was the consensus view among a panel of three regional health care experts at the kickoff on Sept. 17 for California Lutheran University’s Corporate Leader’s breakfast series.
All of the panelists gave the Affordable Care Act an “A” for improved access to care. But for services delivery, Dr. Matteo Dinolfo of UCLA Health gave the Affordable Care Act the highest grade, a “B.” Dinolfo, who is leading UCLA’s expansion into primary care in Ventura County and elsewhere, predicted more consolidation in the industry and increased pressure for a single-payer system.
“The federal government’s hand has been strengthened,” particularly in the area of mandating electronic records, he told about 400 business and community leaders at the Ronald Reagan Library & Presidential Museum in Simi Valley.
Steve Sell, president of Health Net’s Western Region, warned that the execution so far of Obamacare has led to a considerable amount of uncertainty about costs. “For California” and the health care exchange being rolled out this fall he said, “the question is will you make it work — or see a rate shock.”
Panelist Greg Angle, CEO of Los Robles Hospital & Medical Center in Thousand Oaks, said demand for services could soar as more participants flood the system. “There is the potential for us to get crushed,” he said, as thousands of new patients, plus new government mandates for behavioral changes come into place.
The panelists told moderator Jim Rondeau of KCLU that some consolidation of services, conversion to electronic records and an overhaul of thinking about costs are in the cards as ACA implementation proceeds. Dinolfo warned that creating a digital record of millions of Californians has huge start-up expenses. “The costs are not going down. The complexity is startling and it’s a wake-up call for physicians,’’ he said.
Angle said that ACA could provide some unseen benefits for controlling costs, including group visits where patients with common ailments get a chance to interact. “Patients could learn from other patients,” he said.
One of the key issues facing health care providers in the U.S. is what “60 Minutes” and others have described as the staggering difference in costs between medical procedures in the U.S. versus Eurozone countries and Canada. Or the huge differential in prices between what patients without insurance are billed and what insurers or Medicare will actually pay.
Sell said that costs are higher in the U.S. because of U.S. patent protections for some expensive drugs, while Angle said that malpractice insurance payments can add 30 percent or more to the physician services portion of a medical procedure.
Also, the cost of regulation adds significant cost to the system, the panelists agreed.
Dinolfo said he believed the U.S. is in a gradual transition to a single-payer system in which the government ultimately takes over costs for individuals, something that he said could reduce overhead costs. “Most nations” in the industrialized world “have a government run plan,” he said.
In the meantime, the panelists agreed that California will likely be at the leading edge of evolution in the health care field because it has created the Covered California health care exchange and brought thousands more patients into Medical coverage. “California and Minnesota have led the nation” in moving from cost-based health care to a wellness-based system for reimbursement, said Sell.