Saturday, February 5, 2011

Consequences of Health Reform

You may wonder why I have not been blogging these last three days. I have spent my entire time the last three blogless days creating an index for my book Good Intentions: Consequences of Health Reform.

The book's theme is mundane. Reform has consequences, good and bad.

The main good consequence is insuring 32 million more Americans.

The chief bad consequence is loss of individual freedoms.

The title for the book comes from Samuel Johnson’s famous quote, “Hell is paved with good intentions.” Of course, the health reform law is more complicated than that. It is “fiendishly complicated” in the words of Humphrey Taylor, chairman of Harris Polls. According to Jonathan Oberlander, a health policy wonk at the University of North Carolina, the law’s problems stem from this not-so-simple set of realities,

“The law suffers from something of an identity crisis. After all, unlike Medicare or Social Security, the ACA is not a single program. Rather, it is a collection of mandates, public insurance expansions, subsidies, and regulations that affect different groups of Americans in different ways and at different times. During the reform debate, Democrats were never able to stitch those disparate elements together and give insured Americans — including Medicare beneficiaries, a politically crucial constituency — a simple, coherent story about how the ACA would benefit them."

In my foreword, I put it this way,

“The health reform law is a many splintered thing, a product of American diversity, political partisanship, fragmented care, and a search for the right balance between government authority and individual freedoms. These freedoms include the right of doctors and patients to make decisions based on the patient’s best interests.”

I won’t get into the details of the book. Suffice it to say, the American public is concerned mostly about cost and access, American politicians about power and voters, American physicians about autonomy and regulations, American elites with universality and equity, American states with Medicaid-induced bankruptcies, and the American digiterati with Internet applications.

A word about the latter. As we rush to get “on line,” to make the transition from the human mind to circuit-driven technologies, we risk abandoning the core promises of humanity – individuality and human choice.

We may try to use the computer to explain too much, too monitor too much, and to unlock the recesses of the human mind. It may come down to Twitterdee, Twitterdum in 140 characters or less.

Tweet: In his book Good Intentions: Consequences of Health Reform, Doctor Richard Reece says honorable intentions aren’t enough for most of us.

Richard L. Reece, MD, blogs a Medinnovation and has a website under construction. He is the author of three recent books, Obama, Doctors, and Health Reform (Iuniverse, 2009), Innovation Driven Health Care (Jones and Bartlett, 2007), and an E-book, Pros and Cons of Accountable Care Organizations (Practice Support Resources, 2011). He works with The Physicians Foundation, a 501C3 organization representing physicians in state medical societies. Opinions expressed in his blogs are his alone. He can be reached at, 860-395-1501

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