Health Care Reform and the American Congress.

A s a longtime health policy reformer, I have come to love Winston Churchill’s observation that American policymakers always get it right, but only after trying everything else. I am also beholden to my now deceased Alabama Democratic colleague Senator Howell Heflin’s explanation of Congressman Claude Pepper’s (D-FL) interview with God after Pepper’s death in 1989. In Heflin’s telling, Pepper asked God if we would ever get health reform right in America, to which God replied, “I have good news and bad news. The good news is, yes, Americans will eventually get it right. The bad news is, not in my lifetime.” Even though we have not “tried everything else” (including single-payer financing), and even though politics in America is about as discouraging as it’s been in my lifetime, nearly 50 years of involvement in health reform tells me that someday there will be an affordable American health system available to all. The foundation for such a policy reform was established with the passage in 2010 of the Affordable Care Act (ACA). At its heart, the ACA broadens coverage and changes financing policy from fee-for-service to value-based outcomes and population health improvement. American communities are building on this foundation and contributing their experiences to future policy improvements. The ACA represents nearly 4 decades of accumulated experiences with health care payment policy reform at the state and federal levels, bolstered by health services research that has translated these experiences into policy. It is this approach, not partisan politics, that has long been at the heart of health care policy improvement in America. As everyone knows, the ACA became law only because a Democratic president and Democratic members of Congress seized one of those “If not us, who, if not now, when?” moments in our history. Unfortunately, every single elected Republican congressman chose to oppose passage.