The post below discussed the distinction between the passage of a well-intentioned health care law and the final desired health care benefits. Too often the media, politicians and the public act as if a law's passage and enactment is the end goal. They forget that a law is an intermediate step that sets in motion many agents to achieve the desired result. Until a law is implemented and running for several years, there is tremendous uncertainty as to the law's ability to achieve the original intended result, especially for such a large undertalking as reforming health care.
Sunday, December 20, 2009
Will Health Care Reform Be Legislative Vaporware?
Posted By Milton Recht
Vaporware, a term from the computer industry where software companies announce their forthcoming release of new beneficial software that never materializes, appropriately applies to health care reform legislation
Congress will pass and the President will sign a health care reform law, but will it accomplish its many goals and have the many promised health care benefits or will it become a law that does not achieve its intended results? Could it actually make the machinery of our health care system function more poorly?
We must not forget that the benefit of this product called "health care" is the outcome to the patient and not its costs or insurability.
Many of us treat a law, such as whatever will pass for health care reform, as a final delivered product with all the previously promised beneficial features. Health reform requires more than the passage of a law called health reform. It requires accomplishing and solving many difficult and not well-understood health care issues.
Many laws are simple in that they do not involve modifying the process of an entire sector of the US economy. Most laws are categorizations that add to or remove from existing processes. A law that declares an action criminal, a felony, a higher fine, a health hazard, taxable, etc. and by declaration adds or subtracts from an existing framework easily achieves its intended results because the passage of the law itself achieves the results.
The well intended passage (and I give Congress and the President the benefit of the doubt that their actions are well intended) of a law in an area as large, as complex and as intertwined as health care requires more than enactment for achieving its original goals. It requires much more than a declaration of Congressional wishes and a redefinition of health care, health insurance, uninsured, etc.
Until any health care law is fully functioning, there is a lot of uncertainty as to its effectiveness, no matter how well intentioned. In the health care debate, our upset was with process and costs, but not outcomes. We never heard that doctors were doing appendectomies wrong or that too many patients with appendicitis died. We heard that appendectomies cost too much out of pocket or that someone could not or did not get affordable insurance to cover the needed medical care.
What we do not yet understand about any health care reform law that passes Congress is how that law will affect health outcomes. It is quite possible, and likely, that any health law making as much of a change to health insurance and health care as will likely pass Congress, will also likely affect delivery and choices of treatment, doctor availability, and health outcomes.
Whether the law will lower costs, decrease the number of uninsured and improve health outcomes is unknown until medicine functions for some time under the new legislation. While many will say it is in any case a first step toward improved health care outcomes, increased insurance availability and lowered costs, and that Congress will modify it as needed, a poorly laid foundation will never result in a quality home. [Emphasis not in original.]
To me, health care reform legislative passage is vaporware. It is solely a promise of beneficial outcomes and intended benefits. Until, the law is functioning for a few years, after all its provisions take effect, will I and the rest of the US know whether a real, functioning, improved, lower cost health care system exists. Until such time, passage of the law is merely an announcement of intended benefits. It is vaporware.
Posted 12/20/2009 04:53:00 AM