January 20, 2011

Economist hits high points of health reform

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Health economist Paul Keckley, Ph.D., was at Vanderbilt last week to speak about federal health care reform legislation. (photo by Mary Donaldson)

Economist hits high points of health reform

Health care reform will not be repealed, health economist Paul Keckley, Ph.D., told a Vanderbilt University audience last week.

“The chance of (the law) being repealed is somewhere between slim and none,” he predicted. “But like every law, it will be fixed, it will be amended, it will be corrected.”

The requirement that everyone buy health coverage or pay a penalty beginning in 2014 also will be affirmed by the courts, Keckley said.

“You don't have an option about buying into Medicare,” he explained. “So we have precedent in law … that the federal government can impose things where there's a market.”

Keckley, executive director of Deloitte Center for Health Solutions in Washington, D.C., formerly directed the Vanderbilt Center for Evidence-based Medicine. His talk at the Vanderbilt University School of Nursing was part of the school's Centennial Lecture Series.

One of the law's most profound provisions will be realized when “comparative effectiveness” data become publicly available, and consumers can compare cost, quality and outcomes, he said.

It's already happening. Growing numbers of people are choosing pharmacy clinics, where they pay $59 instead of $139 for a visit to their doctor's office that took two weeks to schedule and where they had to wait 38 minutes to be seen, Keckley said.

Health care reform will force health care providers — in both the commercial and public health sectors — to integrate into large systems of care. It will push more services into the home.

Vanderbilt's major regional competition may no longer be another hospital system but an alternative delivery model.

Technology is hastening the transformation.

Consumers can access their health records using their cell phones or computerized “personal health systems.”

In places like Vanderbilt, genomic profiles are being added to the electronic medical record.

The bet is that consumers “will know perhaps better than … the doctor or the nurse what the treatment options are and how they should behave,” he said.

Another upheaval will occur in 2014 when the “pay-or-play” provision encourages companies to pay a penalty rather than continue to provide coverage for employees.

Keckley predicted that as many as 70 million people will leave traditional employer-sponsored insurance for health “exchanges.”

Ultimately, U.S. health care will embrace the Swiss model, where taxes fund a basic benefit for everyone, and “if you want more than that … you pay,” he said.

Keckley said Vanderbilt is well positioned to play a leadership role in health reform.

“The challenge is that we be honest brokers of information,” he added. “What's the data say? What's the reality of this?”