With the Supreme Court having upheld most of the Affordable Care Act and ruled that it is constitutional, implementation plans, which have already been in process, are moving into high gear in Seattle and King County. There will be an immense number of changes in the health care system between now and 2014, when the individual mandate kicks in and we finally join the family of developed nations who have universal access to health care.
Access will be guaranteed, but efficiency and effectiveness will require much work on the local level. David Fleming, the Director of Public Health Seattle & King County, is fond of reminding Board members about the challenge by showing us a simple diagram, which matches the amount of money spent in each country with life expectancy. Almost every other country falls onto a line where increased expenditure is correlated with longer life. Only the United States falls way off the curve, with higher expenditures per capita than any other nation, but life expectancy that falls well short of that attained in other industrialized countries. Our system is way more expensive than the results justify.
The Affordable Care Act lays out an ambitious plan to change that by:
- reducing administrative costs
- providing preventive care that will keep people out of expensive emergency rooms
- helping consumers choose health plans based on quality and value
- expanding coverage to people who currently do not have health care insurance, and
- taking a series of other steps to change the system so that we achieve better health in a more cost effective way.
It sounds great, and some of the provisions will work at the federal level (such as the requirement that insurance companies refund to consumers revenues above a certain percentage that were not been spent on actual health care). But most of the work will require considerable effort at the local level to reorganize the system so that it delivers results.
Fortunately, Washington has already taken a leadership position by approving implementing legislation at the State level, including the creation of a health care insurance exchange. At the local level, Public Health has joined with other providers to create the King County Collaborative, which will implement the requirement for Community Health Needs Assessments and defining strategies to improve community health.
Public Health Seattle & King County examined the 11,554 deaths in King County in 2009, and identified approximately 5500 of them as preventable. That’s a pretty extraordinary number! Prevention strategies include reducing smoking, encouraging healthier diets and more physical activity, and reducing the impacts of alcohol, infectious diseases, poisoning, injuries, and drug use. All of these activities can be controlled or managed, and the task of community health prevention is to identify effective strategies and create the programs and funding to implement them.
The City of Seattle is participating in the work of health care reform, and we will do our part to create a model that can not only increase the health of our residents, but be the kind of approach that other communities will be able to replicate in order to improve their health. We have a long track record of innovation:
- Creating Group Health Cooperative
- Groundbreaking public health programs
- The Level One Trauma Center at Harborview
- The Seattle Cancer Care Alliance
- Seattle Children’s Hospital
- The myriad of organizations and companies working on global health issues and biotech
- And many others.
The benefits will be extraordinary, and the challenges great. How will the expected increase in Medicaid eligibility be managed (42% more people enrolled)? How will we provide services in mental health, long the step child of health programs, but with a new lease on life under the Affordable Care Act? How will the middle class, now eligible for significant subsidies (up to the level of $92,000 annual income for a family of four) use their new access to health care services? How do we make prevention the top priority? How will our community health clinics expand their services while still maintaining their quality? How will we cut the red tape and administration while still maintaining cost control measures?
We have great capabilities in this community, but it will take all of our ingenuity and commitment to transform this ailing system into a new picture of health. The work is starting and the systems are being put in place. Stay tuned for the revolution.