Executive office update: Judgment Day? It’s not about policy or politics

Tuesday, May 01, 2012 01:07 PM

Alfred Gilchrist, Chief Executive Officer
Colorado Medical Society

At some precipitous moment this summer, the U.S. Supreme Court will potentially resolve the hyper-technical legal argument as to whether health care is “commerce” that may be coerced or compelled by the federal government. In the rare atmosphere of the Supreme Court, it’s not about policy, it’s about law – and hopefully, it’s not about politics.

As our friend Ed Dauer, Dean Emeritus of the DU Law School, argued in an expert panel on this subject at our Spring Conference in early May, judgment day in most respects may have little to do with health care. You can listen to his comments on our homepage at www.cms.org. The fact is, we are going to continue along an already developed policy trajectory to address the challenges of providing health care in our state that is available, affordable and of good value. The Supreme Court will either limit or confirm the role of the federal government in that critical endeavor.

No matter the ruling, physicians will continue to press the case and lead a systems-approach to health care delivery. We live in a state that is advanced in the pursuit of care coordination and finding the ways and the means to collaborate on homegrown, locally-owned solutions.

If the “everybody in the risk-pool” concept stays put, we bear down on the development of the Colorado Health Insurance Exchange, a complex undertaking on its own. But if the mandate is ruled unconstitutional, medicine must determine whether to lead, follow or wander—which was the theme of the Spring Conference.

Should we support our own version of a Massachusetts-style coverage scheme, and an accompanying insurance regulatory framework to support it? Should we wait and see what Gov. John Hickenlooper’s TBD Colorado Health Care produces and support his plan? Will a robust cost containment package need to travel with coverage provisions? Will the 2012 election cycle produce a political center that can find answers to these questions instead of blame?

While we have thoughtful polices developed by our Physicians’ Congress for Health Care Reform, we are once again engaging our members and asking for additional ideas through an on-line tool developed by a physician spouse (see story on page 15). We’ll bring it all together at the Annual Meeting in September so our top policy making body, the House of Delegates, can give us a consensus.

Presuming the Supreme Court upholds the Medicaid expansion, we are part of a larger debate on how we afford it. The urgency of that objective is reflected in Medicaid’s new Accountable Care Collaborative, a system redesign effort incubated by CMS and a number of state specialty societies that went into effect just this year.

In a digital age and an information-based economy, health services are just a few keystrokes away from unbridled transparency and accountability. Every aspect of care delivery will experience real time scrutiny. What follows will be a long-term debate over the cost, price and efficacy of every test, procedure and exam.

The Supreme Court’s role is less game changer than game arranger. The Great Game is already on.