Hallelujah! Hallelujah! Hall-e-lu-jah!
The Court has affirmed the Individual Mandate as a tax! The Court has supported the Medicaid Expansion!
Clearly, the Supreme Court has followed some key principles enshrined in our defining national documents. Our Declaration of Independence seeks independence in order to “promote life, liberty, and the pursuit of happiness.” The preamble to our Constitution seeks to “promote the general welfare.” Promoting life, the pursuit of happiness, and the general welfare are intimately related to good health: none are achievable without it. Hence, a very strong basis exists in the earliest documents of our country for our national government to become engaged in actions that promote the good health of all Americans.
The 14th Amendment to the Constitution guarantees equal protection under the law for all Americans. A restatement of this protection is “we value all people equally.” This is a clear basis for the dictum of social justice in our civic life. In health care, this can be interpreted to mean that our national government has the obligation to undertake efforts to reduce health disparities by actions that promote and maintain equity.
When we combine the principle of good health as a basic concept and the dictum to promote equity, we have a very, very strong basis for arguing that our national government must undertake national health reform efforts to foster the conditions under which life, happiness, and the general welfare can actually be pursued. In fact, it is precisely to promote these goals that the United States of America was formed originally. We have strong reason to celebrate this July 4th!
Now, we must press ahead with core reforms in care delivery that are already underway. Catalyzed by the affirmation of the Affordable Care Act (ACA), these reforms will be key to the nature of the care delivery system that is taking shape now. These reforms certainly will be with us as we prepare to move into the third decade of the 21st Century.
The principal foci of the ACA are coverage and access. In fact, both features of the Supreme Court Case—individual mandate and Medicaid expansion—are about these issues. The ACA gives much less attention to the actual configuration of care delivery going forward. Yet, a few moments reflection will help you realize that health reform can be done by insurance expansion and care reconfiguration. Here, I would like to explore care reconfiguration a little further.
By care reconfiguration, I mean how we approach service delivery, who delivers the care, how we combine our organizational resources, and how we allocate our available dollars. At the moment, all are in rapid flux. Here, I would like to explore the rugged landscape of these changes, which are typically done quietly. Included are: