During the course of final debate, no Republican member of Congress voted in favor of passing the bills. Republicans railed against the package as bloated and unaffordable at the Congressional Budget Office estimated price tag of $940 billion over 10 years, despite CBO assurance that the legislation also would reduce the deficit by $143 billion over the same period.
Republican opponents also said the legislation gave the federal government too great a role and would interfere with the relationship between patients and their doctors.
The bills were supported by the American Medical Association and other physician organizations. AMA president Dr. J. James Rohack said that the legislation would do many good things, such as improve health by expanding coverage to millions of uninsured Americans, eliminate denials based on preexisting conditions, provide bonus payments to primary care physicians and general surgeons, and fund pilot projects on ways to resolve medical liability claims.
However, Congress still has work to do on some provisions, especially the one that establishes an Independent Payment Advisory Board (IPAB), the AMA said. The 15-member IPAB, which is set to begin its work in 2014, is charged with presenting proposals to Congress that would slow the growth of Medicare and private health care spending and improve the quality of care.
The AMA said that this board needs to be overseen by Congress and have input from physicians. “The current IPAB framework could result in misguided payment cuts that undermine access to care and destabilize health care delivery,” Dr. Rohack warned in a statement.
The board should be truly independent and include adequate representation from the cognitive specialties, Dr. Turton said.
Facing the Challenge of Changing a Fragmented System
Given the unsustainable nature of the U.S. health care system, change was inevitable. The reform legislation starts a process of rethinking how health care can be more effective, efficient, and sustainable.
Change, however, is and will be disruptive and disconcerting. Managing the reform process will not be easy as patients, providers, and advocates deal with uncertainty and resource allocation in an era of financial limitations. The key issue to keep in mind is that doing nothing would soon bring on similar stress, but with somewhat different variables.
How we harmonize professional activities in a fragmented health care system may turn out to be the predominant theme during the next few years.