Let the Work Begin !

It is hard not to be amazed by the accomplishment of our President, Barack Obama, in getting a complex, far-reaching, health reform bill through the legislature. It took his focused vision and a determination to use the mandate of his election to make it happen – the most important health care legislation in the nearly 50 years since Medicare and Medicaid were enacted.

Lest anyone think that politicians truly represent their constituents one needs only to look at the unified position the Republicans took against the health reform bill. It was summed up best at the beginning of the debate on health reform when the Republicans declared that they needed to beat Obama on health care to bring down his administration. They tried. They lost. The American people won.

Now comes the time to make health reform work. To do that we will need to focus on a few important issues. First, we must insist on forward motion, paying no attention to the remaining opposition. Passage of the bill is only the first step. Implementation of the many opportunities we now have will require all of our attention and our creativity as health professionals. Second, we will quickly need to focus on the question of primary care supply. In the two free clinics that are run by our Institute for Family Health, more than half of the people who come for care come for preventive health services and for the management of common chronic illnesses such as hypertension and diabetes –the effective treatment of which is closely linked to improved health outcomes and reduced health care costs. But primary and preventive health care providers are in short supply and we will need to address the workforce issues now, or find ourselves with a newly insured population with nowhere to use their new insurance card. During the Clinton health reform attempt I appeared on McNeil-Lehrer on PBS and said “Even if every American were to get an insurance card today – most would have nowhere to take it – especially if they live in the inner-city or in a remote rural area.” Unfortunately, years later the story is still the same.

Even with these issues ahead of us, one thing is undeniable. Lack of health insurance disproportionately effects people of color in New York City and New York State and across other areas of this country. To the extent that lack of insurance is also closely tied to delays in care and worse outcomes for almost every condition studied, providing insurance for tens of millions more Americans will help to decrease (but not eliminate) health disparities between people of color and whites. And for that reason alone, we should celebrate!

Let the work begin!