Reform School

Health care reform.

Amazing how these three little words generates vigorous (and occasionally heated) discussion no matter where we go. Seems everyone understands this trilogy of words (short for the Patient Protection and Affordable Care Act or PPACA) represent changes reshaping the way you and I receive medical services. Our national legislators implemented laws designed (right or wrong) to broaden coverage and mandated changes with intent to improve our health care system. No matter what health care in the U.S. will never be the same.

Readers know we’re all about prevention. Fixing it before it breaks. Apparently, so were the architects of the new health plan. Our current national health insurance (Medicare) historically showed no interest in covering preventive services. Health care providers could treat and receive reimbursement for discovering and treating “signs, symptoms or injury.” For years, health care providers learned and followed the “no prevention please” mandate. We knew it didn’t make sense. Ignoring health problems conceivably found today could prevent significant health care expenditures in the future.

Now (at least by laws enacted in 2008), it seems Medicare gets it. Afraid of opening Pandora’s box and covering anything and everything, legislators knew there must be limits. Otherwise we’re back to uncontrolled growth of health care expenditures. A government agency we should get to know very well decides what to cover and why. The PPACA charged the U.S. Preventative Services Task Force (USPSTF), formed by the Agency for Healthcare Research and Quality, as the authority on what preventive services to cover. They become, as former President George W. Bush would say, ‘the decider‘.

The USPSTF researches the scientific evidence supporting, or refuting, the effectiveness of many different types of clinical preventative services. They give services a grade of effectiveness (A, B, C, D or I), with those services receiving an A or B rating as being highly recommended. A health screen getting an A or B recommendation also prompted the White House to mandate coverage by our health plans at no charge to us. Reportedly, we’re not held responsible for co-payments, deductibles or other charges to get blood pressure screenings, cholesterol checks, certain covered cancer screens and some vaccinations. Of course this means that coverage for other less defined services is not available, at least until more evidence of effectiveness becomes available.

Maybe if we take advantage of these recommendations we can find and prevent problems before they occur. Living healthier by prevention may mean fewer pills, prodding and pokes. And it’s always nice to see that Uncle Sam finally understands that spending money now saves lives later.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

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