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Health system changing with or without reform


Obamacare will stand.

The U.S. Supreme Court last week upheld the constitutionality of the Patient Protection and Affordable Care Act, including the notion that individuals could face federal tax penalties if they failed to purchase some level of health insurance by 2014. That could put as many as 40 million uninsured Americans into the coverage rolls — and potentially into prescription drug coverage — by the time the health-reform law is fully enacted.

No surprise, reaction from retailers is mixed. Such retail pharmacy groups as the National Association of Chain Drug Stores and the National Community Pharmacists Association are cautiously supportive of many elements of the health-reform law that boost prescription coverage for millions more Americans; establish some fair reimbursement standards; and potentially expand the role pharmacists play in preventive health care, accountable care organizations, medical homes and medication therapy management. But the National Retail Federation is vowing to continue working to overturn the law after the 2012 presidential and congressional elections.

The main sticking point, said NRF president and CEO Matthew Shay, is that "the law wrongly focuses more on penalizing employers and the private sector than reducing health costs."

With or without the Supreme Court’s approval, the forces driving a massive reform of the overextended and unsustainably expensive U.S. healthcare model are unstoppable. "The feds have already put $13 billion into implanting this law," noted Ann Berkey, SVP public affairs for McKesson, at a public policy forum for independent pharmacy owners last week in Las Vegas. And with or without the health-reform law, she said, "The market forces will continue" to drive a more cost-efficient, outcomes-based health delivery and reimbursement system in the U.S. "Pharmacists," Berkey added, “are a huge part of the solution," with "a terrific value to bring" to that system.

It's a question both of cost and modernization.

The cost issue is well documented and downright scary. The Congressional Budget Office notes that "Growth in spending on healthcare programs is one of the central fiscal challenges facing the federal government ... Healthcare spending per person has grown faster than the nation's economic output per person by nearly 2 percentage points per year, on average, for the past several decades."

Not to be overlooked is the powerful role that computerization and electronic health records are playing in knocking down the isolated decision-making silos that have evolved and persisted over generations of American healthcare delivery. Steven Burrill, CEO of Burrill & Co., a financial services firm focused on life sciences, notes that health care is dramatically changing "with or without health reform legislation… as the convergence of information technology, wireless connectivity, and low-cost monitors will provide us with real-time information about our own health and wellness, and put individuals in unprecedented control of their own health."

Other nations have rebooted their healthcare systems in a quest for sustainable costs, improved health for their citizenry and expanded eligibility. Is America on the right track with its own health system overhaul?

Some predict that the tempest over reform will die down over the next few years as insurers, providers and patients adapt to the new model and learn to blend free-enterprise principles with government coverage guarantees and cost-control efforts. Are they right?

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