Health reform has just begun

"The end of the beginning." Winston Churchill's famous words aptly describe the status of health reform in the US.

“The end of the beginning.”  Winston Churchill's famous words aptly describe the status of health reform in the US. 

President Obama signed the Patient Protection and Affordable Care Act into law earlier this year. Passing the bill was enormously complicated but, believe it or not, now comes the hard part. The legislation defines destinations. And it includes some specific benchmarks along the way.

But it is left to the government departments and agencies to design the roads and build the infrastructure that all of us – providers, patients, payers, drug companies, device manufacturers, and communicators – must follow. 

Lobbyists and everyone with a point of view are working hard to define what the new law means for them, their clients, and their members. It's also becoming clear that those actually charged with delivering healthcare know very little about what the law does and does not do. And they are having a hard time explaining all of that to their patients and their communities. 

The secretaries, assistant secretaries, directors, administrators, and staff at the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, the Food and Drug Administration, and others have enormously important jobs and much has been left to their discretion. 

Think about it: the words “the secretary/administrator shall … ” appear 4,165 times in the legislation. The words “the secretary/administrator may …” appear 1,178 times. 

Those who work at quasi-governmental agencies, like the Institute of Medicine, the Agency for Healthcare Research and Quality, and the Medicare Payment Advisory Commission will be involved as well. These are the people who will determine how comparative effectiveness research is done; they will decide what measures will be used to ensure quality improvement; they'll pick the people who will serve on the Independent Medicare Advisory Board and the National Prevention, Health Promotion and Public Health Council.

The bottom line is that all who have a stake in the healthcare delivery system – and that includes all of us – must stay involved as the process moves from Capitol Hill to agencies and departments scattered throughout Washington and its suburbs.

As communicators, we have an opportunity to help our clients shape our healthcare future and a responsibility to understand what these changes mean for them … and for us.

Bob Chandler is co-founder and principal of Chandler Chicco Companies.

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