Costs will measure success

Less than two weeks after President Obama signed the health-care overhaul bill, passions haven’t quieted much, pro or con.

A lawsuit by 14 state attorneys general, including Washington’s Rob McKenna, challenges the new law’s mandate that individuals obtain health insurance. It’s a constitutional question that was bound to be brought up, and needs to be answered, but the suit immediately became a political lightning rod.

Some Republican leaders are making repeal of the legislation — an impossible outcome, at least while a Democratic president wields a veto pen for the next three years — a rallying cry for this year’s midterm congressional elections.

The political rhetoric, however, obscures the reality that change will soon be under way. The real work of health-care reform will take place in neighborhood clinics and community hospitals, including those here in Snohomish County. That’s where, over time, commitment, energy and innovation will decide the most important challenge of health-care reform: Whether it can reverse the escalation of costs that threaten the nation’s health-care system and our entire economic future. Failure there will mean failure of reform, and dire consequences for decades to come.

Dr. Atul Gawande, a Boston surgeon who has written extensively on health-care reform for the New Yorker, reminded readers last week that nearly all the gains wage earners made over the past 30 years went to paying for health care, the cost of which has been rising at twice the rate of inflation.

The health bill’s strategy on costs, Gawande wrote, is “the one truly scary thing about health reform: far from being a government takeover, it counts on local communities and clinicians for success.”

Rising costs, he said, have been fueled by a system that pays for the quantity of care rather than the value of it. Turning that around will require fundamental changes in how providers work with patients and each other, and the health-care package establishes incentives and pilot programs that will help. Providers in our region have been leaders in finding ways to improve the efficiency and effectiveness of care, and their innovations will continue to be watched by the rest of the country.

The long-needed overhaul of our health-care system is just beginning. The new law is huge and far-reaching, and will need to be adjusted and improved over time as more is learned about what works and what doesn’t. Good ideas from Republicans — such as meaningful malpractice reform — can make it better.

As the political wrangling continues, the real test of reform will be whether significant gains are made in controlling the cost of care while improving quality. It will take place in clinics and hospitals, not in courtrooms or Congress.