The ACA has set the stage. The law has 2 major thematic aspects. The first, and by far the most visible in public discourse, extends health care coverage through a combination of Medicaid expansion and subsidies on newly established private insurance marketplaces. The second aspect of the ACA, far less often discussed in the public arena, is not about coverage; it is about changing the way in which health care is delivered and experienced. The mechanisms the ACA offers are numerous and the potential is profound. The response to this second theme, changing care, has been substantial, accelerating the adoption of new care structures in both the public and private sectors
Continued reliance on the ACA alone is wholly insufficient to accelerate delivery system reform to the level needed.
Leaders from within health care should now more firmly take the tiller. To borrow a phrase contributed by Splaine and colleagues. it is time to move from change forced from the “outside in” to change led from the “inside out.”
Today’s polarized politics too often prevent authentic dialogue and exploration in the public arena that are essential in designing a better system of care. For example, the toxic and ill-informed “death panel” rhetoric in Washington stalled meaningful policies to improve the care of those with advanced illness
Needed, and now forming under the aegis of the Institute for Healthcare Improvement, is a Leadership Alliance of major health care organizations that commit publicly to partnering with their patients, and
The current ongoing discussions about repeal of the ACA are moot, and assembling a littany of complaints skirts the real issues.
The Supreme Court is currently reviewing the ACA
The arguments have little to do with health care and paient welfare, and much to do with the balance of powers in the three powers of government, constitutional law, and self-interest groups.
Published Online: March 26, 2015. doi:10.1001/jama.2015.2830.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
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