In these very early days of January, I am predicting that “access” will be the word of the year for 2014, especially in healthcare. Merriam-Webster defines access as “a way of being able to use or get something.” As the Affordable Care Act goes into full swing, we’re confronted by a number of troubling questions on this score. Will Americans have access to the doctors they need? Will they have access to the pharmaceutical products their doctors wish to prescribe? And will products and services be affordable, so patients can actually “use” them?
The proverbial crystal ball remains beyond our reach. But insurance enrollment snags and barriers remain, especially in minority communities, according to a January 3 report from Kaiser Health News. People who primarily speak Spanish “are largely being left out of the first wave of coverage under Obamacare,” the report notes. And even if all such issues were solved to everyone’s satisfaction – a very high hurdle — the forecasts of many medical associations and health organizations present a mixed picture on the availability of care. In a position statement urging Congress to lift the long-standing freeze in Medicare’s support for medical training, the Association of American Medical Colleges predicts that we will face a shortage of 45,000 primary care physicians over the coming decade, along with an equal or greater deficit of surgeons and other specialists.
In addition, there are concerns that our transition to a new health system is destabilizing cherished prerogatives such as physician autonomy and patient choice. We all know that medical costs must be brought under control. Does that mean payers have the freedom to define therapeutic options? The answer rests on the strength of the patient’s voice. Advocacy groups can make a tremendous difference as these uncertainties are resolved. But to be effective, groups will have to work harder on both the national and state level. Relationships among patient groups, providers of care and suppliers of cutting-edge therapies must be strengthened and made more nimble, so that all three groups of stakeholders can be activated on short notice when patients’ interests are breached.
The goal, as we see it, is not to pit one constituency against another as the Affordable Care Act finds its ground. Each party, starting with patient advocates, must make well-orchestrated efforts, of course. But at the same time, a spirit of compromise must prevail as each party arrives at the table. Working together, we can protect Americans’ rights to use the healthcare they have and to acquire the healthcare they need.