Health Train Express is the Engine pulling or pushing ?

We all know that train engines can pull a train, or push from beind ?  The advantage of pulling the train is that the  engineer can see where he is going and where there might be obstacles on the track, a car, a broken rail, a rock, or any object that could derail  the train.  If the engine is in the rear...it pushes blindly, unless there is an observer in the first car. Perhaps a video monitor would suffice.

The analogy is about health care reform. Although many previoiusly uninsured now are counted as insured, this does not mean that all will receive health care.

The Affordable Care Act sets into play many steps on the journey of health reform. It looks like an all or none plan, destined to jump off the tracks at speed without considering turns or hills or obstacles. Thus far we have seen changes by executive order which have created concerns about the law being changed without congressional approval at the whim of the chief executive.  Most of it was do to poor planning on enrollment methodology, and some due to provider inability to comply in a timely fashion with the law.  None of this increases confidence in the law.

We in our daily work as physicians know all to well the working of our clinic and the work flow. We know  how and why claims are denied, the need for privacy and confidentiality and much more.

We have seen what digital health has done to privacy and confidentiality.

The complexity of our system has increased leading to more possibility for mistakes. The cost of the changes are being ignored in the calculation of savings.

Yes, the main driver of cost is utilization.

Who are the  drivers and sources for health reform ?

1. One can point fingers at state and federal regulators
2. The changes are so complex that it takes an army of consultants, who forever are holding meetings annually just to  assist providers with instructions on compliance. And here are some examples ofv groups and their agenda.

     CAPG               AGENDA 

   AMA This site from the Medicare News Group lists the portions of the ACA which the AMA      supports as well as those the AMA  opposes