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BLOG: A new day in health care reform
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As election season grows to a close here in America, change again looms on the horizon for the American health care system.
The shift in the House of Representatives will create a new balance of power in Washington that may again address the needed changes in health care and move us to substantive reform.
This is not just any Congress. This election cycle provided 35 new women in the House, bring the total to over 100. The Senate also had an increase of two seats to be held by a woman, bringing the total to 12.
Congress will also see other new minorities representatives including African-American, Native American, Muslim women and LGBT [lesbian, gay, bisexual, transgender] members. The new House will also include the largest number of veterans in over 10 years. These veterans are also much different from the veteran segment of Congresses of the past. This group is younger with more women and affected by different conflicts than the traditional warriors the last century.
This welcomed diversity of people from different backgrounds with new ideas may be just the breath of fresh air that is needed in a stagnant American health care system. This group of people have experienced our system from a different perspective. The veterans have experienced both CHAMPUS [Civilian Health and Medical Program of the Uniformed Services] and the VA healthcare system. The women and minority representatives have also faced different challenges in attempting access health care for their families.
We saw a lot of change in the Obama years. Hope and change were the talk of the day. We had a lot of hope, but many of the changes were not executed in a successful manner, and the end result seldom matched the intent of the legislation. Grandiose sweeping changes in top-down health care reform often don’t achieve the desired effect in the exam room.
This summer, our friends in Australia attempted to roll out sweeping changes in their country with a national electronic health record (Kim). This program, “My Health Record,” faced similar problems as we saw here in the land of the free with the rollout of HealthCare.gov in 2013.
Sweeping change programs need to be followed up with matriculate details of tests and small-scale implementation. This is best achieved with pilot programs and demonstration projects with the adoption of “best practices.” Unfortunately, we like to roll out sweeping change, which is often followed by changes in the political winds and no follow-up to fix and modify these struggling new programs, while in the exam room, both providers and patients are left holding the bag.
In optometry, we diligently worked to master cumbersome electronic health records with the hope that we would be able to move out of the eye care “silo” and be able to communicate with the mainstream health care system. We struggled to create transportable data packages in the proper C-CDA [consolidated-clinical document architecture] format on each patient. We went on the onerous government website to testify the we were meeting all the measures of “Meaningful Use” and yet here, 7 years later, not one C-CDA file has left our office and landed in the EHR of a primary care physician, and we are yet to receive one back. This is in spite of implementing the expensive “direct address” software to send and receive HIPAA-compliant files across the Internet.
And so, as the eternal optimist, I welcome the fresh air in Congress and am once again filled with “hope for change.” You don’t measure change in health care reform with a wrist watch; you need a long-term calendar.
Reference:
Kim O. Is the grass the same colour? Reflections on national governments implementing health care initiatives. Health Affairs. Posted November 8, 2018.