Critical Issues in U.S. Health Care – Health Care on the Edge

 “The U.S. health care system has reached a tipping point when there is both little doubt about the kind of change that is needed and much uncertainty about how to achieve it,” write Joshua Sharfstein, M.D., of the Department of Health and Mental Hygiene, Baltimore, and colleagues in an editorial appearing in the November 13 issue of JAMA, a theme issue on critical issues in U.S. health care.

Dr. Sharfstein presented the editorial at a JAMA media briefing at the National Press Club in Washington, D.C.

In this editorial, Dr. Sharfstein and co-authors Phil B. Fontanarosa, M.D., M.B.A., Executive Editor, JAMA, and Howard Bauchner, M.D., Editor in Chief, JAMA, provide an overview of articles in the JAMA theme issue, and of some of the issues facing U.S. health care.

“At the national level, progress in advancing health care is slow and halting. The Centers for Medicare & Medicaid Services is promoting accountable care and other innovations through the Medicare and Medicaid programs. However, broad changes are not on the horizon, and Congress is distracted by efforts to undo the Accountable Care Act (ACA). Ironically, addressing the increasing costs of health care would reduce the pressure on the federal budget and make political conflicts in Washington easier to resolve.”

The authors write that at the state level, there is evidence of application of some of the principles underlying ideas presented in several Viewpoints in this issue, with increasing efforts and movements to change health care. “There are bundled payments in Arkansas, coordinated care organizations in Oregon, health care cost targets in Massachusetts, and global budgets for hospital care in Maryland—each championed by the states’ respective governor. These efforts involve states setting down the ‘railroad tracks’ of a new health care system, such as payment structures and quality measures, while allowing for the actual activity along those tracks to be guided by local physicians, clinics, hospitals, and coordinating systems of care. However, these state efforts do not materialize out of thin air. Each reflects a substantial investment by local leaders of time, effort, and political capital.”

The authors note that the federal government is increasingly supporting efforts by states to move the health care system forward. “The Centers for Medicare & Medicaid Services is providing data to states more readily, waiving rules that conflict with state models, and funding a wide range of innovative strategies. The Centers for Disease Control and Prevention is pushing state public health departments to align efforts with clinical transformation to address chronic illness. Even more federal engagement would be welcome. For example, the Federal Employee Health Benefit Plan and TriCare could actively participate in state initiatives. The Health Services and Resources Administration could require its grantees, including community health centers, academic institutions, and even poison control centers, to join forces with well-developed local efforts.”

“This generation’s ‘moon shot’ is an effective and efficient health care system that supports the well-being and dignity of all Americans. Total commitment to this shared goal—by health care professionals, medical societies, medical centers, insurers, policymakers, patient groups, and others—will be necessary for meaningful progress. We hope the articles in this theme issue of JAMA inspire renewed efforts to bring the U.S. health care system back from the edge and, ultimately, serve to help improve the health of the nation,” they conclude.

(doi:10.l001/jama.2013. 282124;