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benzilGuest Post from Deborah L. Benzil, MD, FACS, FAANS
Chair, AANS/CNS Communications and Public Relations Committee
Mount Kismo Medical Group
Columbia University Medical Center
Mt Kisco, New York

“Invention, it must be humbly admitted, does not consist in creating out of void, but out of chaos.” – Mary Shelly

Memory can trick us all but looking back can often help us to understand our options going forward. Throughout the past months, Neurosurgery Blog focused on the Affordable Care Act (ACA), zeroing in on the critical issues of cost, coverage, choice and change.  Before recapping the important topics covered, let us pause a moment to understand the road traveled to the ACA and the implications of that journey.

hcr4Pre-1920: Insurance was limited to “sickness” as the primary concern was lost wages.  Medical care was of limited use.

1920-30: The Depression hurt hospitals, which led to the first insurance plan (Dallas teachers with Baylor Hospital) and the birth of the Blue Cross for coverage of hospital services.

1930-40: Growth and the monopoly of Blue Cross led to the formation of Blue Shield, which covered physician services.

1940-60: There is tremendous growth of insurance industry with the entry of commercial insurers which were less regulated. Insurance as a benefit is a result of WWII issues.

1960s: The American Medical Association (AMA), which always fought against universal coverage, gave way to the establishment of Medicare and Medicaid.

1970s-2010: Modern health care system evolved further with the rapid rise in costs and regulation.

2010: The ACA was passed to address real and perceived challenges of rising costs, uninsured, underinsured and quality concerns.

This history resulted in a system in which patients were conditioned to have unlimited choice and coverage, but at discounted costs that were nearly invisibly absorbed by employers. Insurance carriers were more beholden to their stockholders than to patients. Technology, innovation, and pharmaceuticals combined to alter the landscape of medical interventions. Americans were living decades longer than anticipated at the inception of the Medicare and Medicaid programs. The result was a system challenged by cost, coverage and choice. Out of this relative chaos, change was born. Today, further change is in the wind as the ACA has not delivered on many of the key elements promised.

Cost – When our pocketbooks are impacted, everyone takes notice.

  • Surprise billing was explained and explored by Ezriel Edward Kornel, MD;
  • Dr. Kimon Bekelis covered disparities in cost before and after the ACA;
  • The Independent Payment Advisory Board (IPAB), intended to contain costs, is one of the most controversial and unpopular components of the ACA. IPAB repeal is discussed in a guest blog from Phil Roe, MD (R-Tenn.); and
  • Medical liability reform, is an important element of cost control, was overlooked entirely in the ACA. This topic was covered by Stuart L. Weinstein, MD, spokesperson for the Health Coalition on Liability and Access (HCLA).

Choice – Americans have indicated maintaining choice of their health care providers is a priority.

  • Drs. Clemens M. Schirmer and Deborah L. Benzil illustrate how narrow networks considerably limit patients’ ability to select the physician of their choice; and
  • The ACA’s medical device excise tax is affecting innovation and ultimately may limit patient access to many life-saving therapies. Scott Whitaker, president and CEO of AdvaMed, provides an overview.

CoverageWhile more Americans have insurance than ever, many remain uninsured or underinsured.

  • Coverage of our smallest patients was explored in a piece on Medicaid expansion by Drs. Carrie R. Muh and Sandi Lam.

ChangeWhat changes make sense for today and tomorrow? How can the balance of cost, choice and coverage be found so that Americans can take advantage of all our health care system can and does offer?

  • A new health policy guide helps you navigate change in 2017;
  • The impact of the Open Payments program and accuracy of data is discussed by Drs. Ann M. Parr and Catherine Miller; and
  • A historical view of the ACA and changes was highlighted by Drs. Kurt A. Yaeger and Clemens M. Schirmer in Grand Health Policy Rounds.

Neurosurgery Blog’s goal for this health reform awareness campaign was to confront the good and bad of the ACA, focusing primarily on the impact on the neurosurgical community and our patients. The debate is ongoing, and we will continue to be part of the policy deliberations. America’s neurosurgeons strongly support improving our nation’s health care system, including expanding access to affordable health insurance coverage for every American.

We hope you have learned something, have joined the conversation online by using #HealthReform and will continue to advocate along with us.

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