Good news can be so unkind
When it’s everything you have to
leave behind
I’m lookin’ forward to lookin’ back
On this day

— Over The Rhine, “Looking Forward”


A study from the Commonwealth Fund should serve as the benchmark for measuring the success of the Affordable Care Act (ACA) moving into the future:

A report released Monday by a respected think tank ranks the United States dead last in the quality of its health-care system when compared with 10 other western, industrialized nations, the same spot it occupied in four previous studies by the same organization. Not only did the U.S. fail to move up between 2004 and 2014 — as other nations did with concerted effort and significant reforms — it also has maintained this dubious distinction while spending far more per capita ($8,508) on health care than Norway ($5,669), which has the second most expensive system.


Lenny Bernstein explains that the study serves as a snapshot of the American healthcare system before the implementation of the ACA, when the United Kingdom ($3,405) led the way:

The U.K. diagnosed its health care system’s problems and addressed them, [professor and lead author Karen] Davis said. “They really have moved up over time. A lot of it has been systematic attention to increasing resources in the system,” she said. Officials hired more specialists, gave bonuses to family physicians who meet quality targets and adopted health information systems that allow physicians to easily share information about patients. And everyone has a doctor.

The United States, on the other hand, “ranks behind most countries on many measures of health outcomes, quality, and efficiency. U.S. physicians face particular difficulties receiving timely information, coordinating care, and dealing with administrative hassles,” the report concludes. The U.S. is beginning to catch up as it responds to financial incentives to improve health information systems, and Obamacare should strengthen that effort.


Robert Pearl argues that spending money on better care — instead of more care — would be a positive step in the right direction:

If we want to improve the health of our nation, we need to reduce the cost of medical treatment and stop wasting money on care that adds no value.

Until we reward doctors and hospitals for the quality of care — rather than the quantity of care — we’ll continue to lead the world in spending. But, at the same time, we’ll never lead in superior clinical outcomes. And until we bust the myth that more is better, little is likely to change.


Until someone comes up with a better plan (maybe a single-payor plan eventually, but repealing the ACA and going back to the way things were is not a better plan), this is our best chance to climb to the top of the pack and improve the American healthcare system in three fundamental ways: increase access to care for all, improve the quality of care, and decrease the costs of administering that care.  The momentum forward toward healthcare reform is being embraced — not rejected — by physician groups (like Pediatric Alliance), hospitals, insurers, and employers nationwide.  Some may be reluctant; others have reservations.  But no one, except ideologic politicians and pundits, is moving backwards kicking and screaming like a toddler’s tantrum.  The best news of all is that we’re moving ahead.  Can we do it?

Yes we can.