Earlier this week, in my post “Dog catches bus”, I made the point that passing the law was the easy part. A couple of days later (than HomaFiles), the NYT is on the case.
Punchline: Now an administration that has demonstrated virtually no implementation capability (think stimulus, foreclosures, GITMO …) has to implement the most complex government program in history.
Keep in mind that 8 years after 9-11 — the official start of the high priority initiative to link our intelligence systems — a guy who was ratted out by his own father boarded an airplane with dynamite in his shorts … a “systemic failure”. And we’ll get the healthcare system right ???
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Excerpted from NY Times: Now Comes the Hard Part, March 25, 2010
Much as the Iraq war wasn’t over when American forces conquered Baghdad, so health care reform didn’t end when President Obama signed the bill. If carrying out the legislation doesn’t get the same sustained attention that passing it did, then this week’s historic victory will lose much of its luster.
Health care reform, the most ambitious domestic policy initiative of our time, is now law.
The challenges ahead — for putting the existing plan into action — fall into four categories.
DELIVERING THE DELIVERABLES
President Obama promised that some of the benefits of reform would appear in the first year. For starters, within 90 days the Department of Health and Human Services must set up a high-risk pool as a temporary source of insurance for people who have pre-existing conditions.
Some of the new consumer protections will take effect within six months; first, though, federal officials have to translate that law into regulation.
EDUCATING THE PUBLIC
It’s one thing to create a health insurance program and quite another to get people to sign up for it. Today, many more people are eligible for Medicaid than actually enroll.
An aggressive public relations campaign to increase public knowledge and to undertake direct outreach to individuals will be necessary. While states and nonprofit organizations will play vital roles, the federal government will probably have to take the lead.
HANDLING THE INSURERS
The law creates minimum standards for what insurance covers and requires insurers to spend most of their money on actual patient care.
The states will have primary responsibility for enforcing these standards … that won’t be easy.
BENDING THE COST CURVE
Dozens of new initiatives are intended to control, or at least reduce, the cost of medical care. But most of them require work to get up and running.
There are hopes that wider use of electronic medical records can improve quality while reducing expensive duplication.
Studies show we’d save money if we stopped paying for so many treatments that don’t work (or don’t work better than the alternatives). But we can’t start paying for treatments more intelligently without better information about what drugs and procedures do work, not to mention which ones doctors and hospitals already use.
But, somebody first has to set up a standard for the records.
The Obama administration needs to find the right people to manage these programs.