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The Stages of Health Reform

Posted by John McDonough  August 8, 2012 09:22 PM

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Thinking about the health care cost containment law signed by Governor Deval Patrick this past Monday; it's a milestone. Many see it as positive, and some see it as negative. While it's important, equally important will be the implementation effort. Many, myself included, have confidence in the Patrick Administration's commitment to effective implementation, and less confidence in the commitment of the Governor's successor in 2015, whoever that may be.

So is health reform completed, at least legislatively, in Massachusetts? We had three major access/coverage laws in 1988, 1996, and 2006. And we now have had three cost control laws enacted in 2008, 2010, and 2012. What's left to do?

A lot.

I see full and real health reform as a four-stage process, along these lines:

Health Reform 1.0: Access -- insurance coverage, ability to obtain services

Health Reform 2.0: Delivery System Reform -- cost control, quality improvement, efficiency

Health Reform 3.0: Public Health -- prevention, wellness, population health improvement

Health Reform 4.0: Health in All Policies


National-Prevention-Strategy.jpgThese stages are not strictly sequential. They overlap. Often we move one step forward and two steps back, or just two steps back. Massachusetts has substantially accomplished 1.0, and is hard at work on 2.0. Though the Legislature made progress on 3.0 in the new law by establishing and funding the Prevention and Wellness Trust Fund, it's really just a start -- for example, the $60 million funding commitment doesn't come close to overcoming the severe public health budget cuts of the past four years.

I hope 3.0 is the next push. Earlier today, the Massachusetts Public Health Association hosted a reception to celebrate their victory, joined by their key allies from the Greater Boston Interfaith Organization, Health Care For All, Health Resources in Action, the Boston Public Health Commission, and JALSA. They all deserve a victory lap -- public health takes a lot more losses than wins. Let's hope this is only the start.

The real goal should be 4.0. What do we mean by "health in all policies?" The best example if the National Prevention Strategy, mandated by the Affordable Care Act in 2010 and released by the U.S. Surgeon General Regina Benjamin in 2011. It's an ambitious and creative blueprint for a healthy America. Sitting at the table was not just the US Department of Health & Human Services, but also the federal Departments of Education, Transportation, Housing & Urban Development, Justice, Defense, State, and more. This is the path to true prevention and true population health. It's not a secret plot to expand health care, it's an open path to reduce what we spend on health by building prevention and public health into all public policy.

We're not done, not by a long shot. And we are so far ahead of the rest of the nation. And one key reason is because we put coverage and access first.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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