Looking back, historians may mark 2010 as the most significant year for U.S. medicine in decades. The health care reform legislation signed into law by President Barack Obama on March 23 profoundly changes the way care is provided. And even if opponents succeed in repealing the legislation, the debate itself will shape the way we think about the issue for years to come.
The law didn't come out of nowhere. Stresses and discontents in health care have been building for decades. Costs are rising at the same time that budgets are getting leaner. Most sophisticated tests are forcing doctors and patients to decide whether and how to treat diseases that previously went ignored. And new research calls old guidelines into question.
Year in Health 2010
Bedbugs, health care reform, fatigue…which stories made the most impact in 2010?
The conflict over health care stems largely from a gap between the care we expect and the care we can afford. That gap is now threatening to undermine Medicare, which is scheduled for a 25% cut in reimbursements if Congress doesn't act soon. It could force many doctors to drop Medicare -- which would send shockwaves throughout the system since Medicare patients make up about a third of 70% of physicians' practices. Almost no one wants to see the cuts take place, but the Congressional Budget Office estimates that keeping reimbursements at current levels through 2020 will cost $276 billion. Under pressure to reduce the national deficit, Congress so far hasn't been able to agree on a source for that much money. Throughout 2010, it kept delaying the cut with a series of short-term fixes. What's likely to happen next? More delays. With the Republicans controlling one chamber of Congress and the Democrats the other, gridlock could doom long-term "doc fix" legislation for the coming year.
Whatever else you might say about health care reform, it's a big deal. The most comprehensive overhaul of the nation's health care system at least since Medicare, the Affordable Care Act seeks to dramatically expand the number of people who can afford health care. It does that by subsidizing the cost for those who can't afford it, penalizing those who refuse to buy it, and limiting the cases in which insurers can deny coverage. Among scores of other provisions, it boosts pay for primary care doctors, encourages compensation based on quality of care, and bars co-payments for most preventive services. As the law is implemented, questions about these and other provisions are cropping up. For starters, do we have enough doctors, nurses, and other health care workers to care for an estimated additional 32 million insured? Also, who will make up the difference if fewer co-payments are collected? These questions and more are certain to arise as legislators critical of the law attack it with renewed vigor.