By John E. McDonough
January 24, 2019
For most physicians and physician leaders, health policy is an annoyance and distraction that happens “over there” in Washington DC, state capitals, and elsewhere. The ways and means of politics and policy making are mysterious and not worth the bother.
In today’s U.S. health care system, that attitude makes less and less sense from institutional, professional, and personal points of view.
Health Care, Politics, and Policy
Decisions made by national and state policy makers, elected and appointed, have direct impact on patient access to affordable health insurance, quality medical care, and other essential life-saving needs. These decisions have major consequences for the stability and viability of hospitals and other health care institutions.
The U.S. government has been engaged in a decade-long effort to transform the U.S. health care delivery system from fee-for-service to value-based payment. You may have noticed that these efforts are accompanied by a blizzard of initiatives and catch phrases unrecognizable just a few years ago. Terms such as accountable care organizations (ACOs), bundled payments, and Medicare’s Merit-Based Incentive Payment System (MIPS) keep entering the lexicon and are growing in importance.
Passage of the Affordable Care Act was a milestone in the history of U.S. health policy, on a scale matching the other major health policy law in U.S. history—the 1965 passage of the law that created Medicare and Medicaid. Both Medicare and Medicaid look dramatically different today than they did in 1966 when first put into operation. To understand both of these central health access programs, it’s important to understand how they work today, and how they got from 1965 to today’s versions.
Connecting the Dots—It’s Time to Engage
Especially challenging for busy physician leaders is finding opportunities to connect the dots, to achieve a higher-level understanding of the essential moving parts and how they fit—or don’t fit—together. It’s just not enough to understand today’s headlines regarding ACOs if you can’t appreciate from where it came, how it developed, and why it matters.
Finding the right opportunities to develop this perspective can help physician leaders advance and achieve their own professional and personal goals. It can also help physician leaders to be better guides and interpreters within their own institutions and professional societies. And it can even help physicians to find a better balance between their professional and personal lives.
Physician leaders can also use help figuring out how they can become involved in health policy development and implementation. I like to analogize the U.S. health policy scene as a giant hotel with many entrances on all sides. Once inside, the opportunities are many even though the connections can sometimes be hard to make. In any state or local area, you can find physician leaders who have devoted time at some point in their careers to public service and public policy. These individuals understand how important it is for physicians to engage in public policy and how to make a difference.
John E. McDonough, MPA, DrPH is a professor of practice at the Harvard T.H. Chan School of Public Health. He is the program director of Preparing for What’s Next in U.S. Health Reform, an executive public policy training program for physician leaders and others.
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