Forget for a minute the politicians, the policy-makers, the pundits. Forget the grandstanding and the rhetoric and the sheer wild-eyed goofiness going on inside and outside the halls of Congress. Whatever our esteemed elected leaders decide to do or not do, or undo or redo, or doo-dah-doo, health care is changing. Real, honest-to-God transformation is under way.
It's not the politicians who are leading the change. It's you. If you are a doctor or a nurse or a pharmacist or a hospital CEO or a middle manager or a housekeeper or anybody else toiling away in the health care trenches, you are, at this very minute, transforming care delivery in this country. And you're doing a heckuva job. Bravo.
Everybody's known for ages that our health care system wasn't working the way it should. Lots of people maintain there wasn't even such a thing as an American health care system, it was so disconnected and uncoordinated and inefficient and expensive, and the payment system was so illogical. Now, at long last, you are building a continuum of care in your community; finding places to improve processes and cut unnecessary costs and provide safer, higher-quality services; improving the dissemination of best practices and making those practices standard; and adopting new technologies. Governmental and private-sector forces may have provided the kick in the pants, but you're making it happen.
Which brings us to a major milestone in the transformation: the health insurance exchanges that began enrolling patients today. I won't try to sort through all the ins and outs of the exchanges — or health care marketplace, as the whole enterprise is supposed to be called now. For that, you should read the cover story by Paul Barr in this month's Hospitals & Health Networks. It's called Day One and you can access it here.
But I will say this: Don't panic. The insurance exchanges have the potential to give millions of previously uninsured Americans health care coverage. That should get them better access to primary care and wellness programs. It should cut the number of unnecessary emergency department visits, and it should reduce the number of nonpaying patients who come to hospitals.
There are bound to be glitches — large ones, and plenty of them. It's new. It's big. It's facing organized resistance. Some people will pounce on the glitches as evidence of failure. Can we just be patient and at least try to work out the kinks before we throw in the towel altogether?
Here's what Chris Van Gorder, president and CEO of Scripps Health in San Diego, said yesterday on the eve of the rollout of California's exchange:
"It will take months for the impact of the new insurance markets and other ACA initiatives to play out. … No matter what happens with the exchanges, health care in this country is changing and must keep evolving, because it is broken. This crisis presents a challenge and an incredible opportunity for physicians and hospitals to fundamentally reshape the future of health care."
In his statement, Van Gorder goes on, "I expect the implementation of the exchange will probably be messy at first, and I'm sure one side will focus on all the positive stories, while the other will focus on the negatives … But while the ACA and its initiatives may not be perfect, it is the law of the land, and it is a step toward addressing this nation's health care problems."
At long last, health care is getting itself on course, however bumpy and zigzaggy the course might be at first. If we all stay calm and focused, we can straighten everything out and eventually get to where we want to be. And it's you folks out there in the real world, not the D.C. ding-dongs, who will get us there.