Rounds NEWS FROM AMERICA’S BEST MEDICAL SOCIETY
Health care attorney and economist Thomas P. Miller told physicians at the 2012 TMA Fall Conference that health system reform must improve health, be patient driven, and promote accountability, without micromanaging the delivery of care.
lays in federal rulemaking, and a slow economy have meant that health system reform has not received the same level of prominence as it did in the run-up to the 2010 elections. Despite what Mr. Miller called a “near- death experience,” PPACA survived a U.S. Supreme Court challenge, albeit with some constraints. The decision, for example, did not endorse the law as a valid exercise of the government’s au- thority to regulate health care as com- merce, rather within its power to tax. Judges also said forcing states to expand their Medicaid programs went too far. Even if PPACA is implemented as planned, budget constraints abound, Mr. Miller said, and questions remain as to “how viable [the individual mandate to purchase health insurance] will be down the road.” For example, plans participat- ing in the state or federally run health insurance exchanges likely will face pres- sures “to handle [the Medicaid popula- tion] as the only delivery vehicle for this type of coverage.”
Fall conference keynote speaker dissects what’s next for PPACA
No matter who is president, implementing the Patient Protection and Affordable Care Act (PPACA) — or a replacement — in the wake of the U.S. Supreme Court ruling upholding the law has its challenges, health care economist Thomas P. Miller told physicians at the Texas Medical Association Fall Conference in October. Whatever shape it takes, health reform must improve health, be patient driven,
and promote accountability, without micromanaging the delivery of health care, said Mr. Miller, a former advisor to the U.S. Congress Joint Economic Committee now with the American Enterprise Institute for Public Policy Research, a conservative think tank. States’ resistance in adopting insurance exchanges and Medicaid expansion, de-
If the elections turn the tide toward state-based alternatives, states still must overcome their dependence on federal subsidies for public health care pro- grams, fragmented health care regula- tions, and federal barriers to competitive market solutions. Either way, reform doesn’t happen “until doctors do it,” Mr. Miller charged. “And we need a system that recognizes that providers perform differently and that pays accordingly, not arbitrarily.” Physicians in attendance voiced their
own frustrations with the complexity of health system reform, the lack of inclu- sion of federal liability protections, and
December 2012 TEXAS MEDICINE 11
PHOTOS BY JIM LINCOLN
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