Newtown, CT – January 7, 2017
There’s a little boy. Now on his 14th birthday he gets a horse, and everybody in the village says “How wonderful the boy got a horse,” and the Zen master says “We’ll see.” Two years later the boy falls off the horse, breaks his leg, and everybody in the village says “How terrible,” and the Zen master says “We’ll see.” Then a war breaks out and all the young men have to go off and fight, except the boy can’t cause his leg’s all messed up, and everybody in the village says “How wonderful,” and the Zen master says “We’ll see.”
Gust Avrakotos, Charlie Wilson’s War
With the new Congress working at a furious pace to implement its agenda, including a repeal and replacement of the Affordable Care Act, there has been a significant gnashing of teeth. “How terrible” is the general outcry, but perhaps, as the Zen master suggests, we should wait and see. With the new Secretary of Health and Human Services coming in, some physician organizations are eager to see him get rid of some of the programs mandated by the last Administration. “How wonderful” is the general outcry, but perhaps, as the Zen master suggests, we should wait and see. On both sides of the aisle, and for many of the stakeholders, the hyperbole that marked the election period has simply carried over and the anxieties and hopes are in full display. More often than not, it’s because no one knows what will happen and it seems easier to opine and speculate than to wait and see. There is, however, another approach.
What this means to you: To a large extent, we are entering a new period of: You wanted it, and now you have it. Much like for the last one, it will be essential to maintain an objective and continuous accountability for the outcomes of actions taken. And we have lots of baseline numbers from which we can start the accounting. We know each State’s current uninsured rates and premium costs. We also know their scores on pricing and quality transparency. Our colleagues at CPR are tracking the shift from volume to value-based payments. All of these metrics were instituted to take stock of the effects of the ACA, and now we can simply continue to track them. In fact, we have an obligation to do so in order to collectively gain a better understanding of policy. Perhaps nationwide exchanges with across-state health plan competition will yield lower premiums. Perhaps a spread of voluntary APMs, and a proliferation of experiments will move us faster to higher value than mandated models and a tight focus on ACOs. How terrible some will say. How wonderful some will say. We shall see says I, and we will hold the metrics up high so that all others can see as well.