by Lisa Countryman
On Thursday, the Supreme Court of the United States announced their ruling to uphold the constitutionality of the Affordable Care Act. I spoke with Dr. Ana Valdes, Medical Director of St. Anthony Medical Clinic (pictured at left) about what this may mean for the future of health care in this country.
LC: How will this decision impact how we approach health care?
AV: The big picture for the future of health care is recognizing the importance of prevention and health outcomes. If we don’t address prevention and community health, the costs of care are just going to keep spiraling. The big costs aren’t at the front end (around prevention and community health) they’re at the back end, they’re at the end of life, they’re at the most expensive kind of care, they’re at the hospital end, and the more specialized and expensive testing. The realization of this has been building for a long time, not just from a health care perspective, but from a financial perspective as well.
This decision recognizes that everyone needs health care and should have access to health care, but it also takes a step back and says what really is health care? Health care is health, not just treating illness. Health care reform is also pushing us in that direction, by really looking at prevention, really looking at community health centers as the basis for building up that foundation of a healthy population. We can see this reflected also in the efforts around Healthy People 2010 and Healthy People 2020, where they’re talking about not just individual things like cervical cancer screening rates in your health center, but they actually set those goals around the community.
LC: What challenges do you see down the road?
AV: The one piece of it that needs to be figured out is reimbursement. Because right now we’re not reimbursing for outcomes, we’re reimbursing for widgets, and those widgets are visits. But if we’re really going to move this country to being healthier, we need to look at the financial aspect and how we reimburse. We need to reward the outcomes, not the widgets. It doesn’t make sense for health care to be a widget-driven industry.
Payment reform will have to happen down the line, because with this economy people can’t afford the widget system any more. The only thing is, we have to see how that payment reform will play out and if it’s really going to be fair to those with the most need i.e. the safety net. They’re the ones with the smallest voice, they have no lobbies, they generally don’t vote. If reforms are driven by those with the biggest voice and the lobbies, which means the hospitals, and the HMOs, and the insurance companies, then it’s going to be a little harder for them.
LC: Everyone has been waiting for so long for this verdict to come out, now that it has, what can we do to ensure the best outcomes?
AV: People should educate themselves about what this means, not just for themselves but overall, because the overall picture also affects us. We have to be aware that we don’t live in a bubble, we live in a community, and everything that goes on in that community affects us. So we all need to educate ourselves; we don’t need to understand all of the details, but we do need to understand the impact, not just for you but for your community. Then I think it’s giving a voice to those who aren’t heard, and that’s where some of the advocacy work that St. Anthony’s does through JEVA can come in. I do this myself by going to Sacramento with CPCA (California Primary Care Association) and by going to Day on the Hill with NACHC (National Association of Community Health Centers) and speaking for those who don’t have a voice in those venues.