Wither ObamaCare? What's an employer to do?

Who knows what fate will become of ObamaCare? But as Republicans in Congress take their whacks and lawsuits threaten to kill the whole thing, Madison health care providers and employers should keep on doing what they are doing to deal with the uncertainty — namely, emphasize preventive care and continue to place more of the decision-making onus on consumers.

In late January, the House of Representatives voted to repeal the controversial health care law, and while the Senate took it up, repeal was defeated 53-47. Expect aggressive attempts to defund parts of it. (Fortunately for small businesses, one part is on its way to repeal — a burdensome bookkeeping requirement that businesses report purchases of goods or services of more than $600 from single vendors during a calendar year. The measure has passed the U.S. Senate, it is poised to pass in the House, and President Obama has signaled his support for repeal.)

Meanwhile, Federal Judge Roger Vinson has declared the law unconstitutional, affirming the views of 26 state attorneys general and setting the stage for a Supreme Court showdown.

How are local employers supposed to approach a law in limbo? Thank their lucky stars that a lot of serious thought has gone into the distortions of the health care system, especially here. Various geographic regions would do well to emulate the Madison health care community, which enjoys public approval ratings that would be the envy of some pop culture figures.

That didn't happen by accident. It's not just that the area is served by physician directed HMOs, which are more likely to please health care consumers than publicly traded insurers who must first please shareholders. It's that local providers, joined by local employers, have been increasingly innovative in controlling costs without suffering a qualitative nosedive.

If this all sounds like a sugary pat on the back, fine. It's also well deserved.

Local providers continue to wring costs out of what they budget; they incorporate plan changes that keep down premiums; and they intensify the employee focus on preventive care and wellness, which impacts utilization and therefore cost.

Cost-sharing in the form of higher deductibles and co-pays may be decried in some circles, but it does bring more sensitivity to how care is utilized, and value-based purchasing has helped advance a more efficient culture.

They also continue to work on process improvement, which preceded the deployment of electronic medical records and the decision, enabled by Epic Systems' Care Everywhere, to electronically share patient data in emergency care settings. What other regions are still talking about, Madison has done.

No system or plan is perfect, but lower Medicare reimbursement, which is called for in the new health care law, already has begun. That will drive more efficiency.

Donald Berwick, President Obama's pick to serve as the administrator of the Centers for Medicare & Medicaid Services, would no doubt applaud all this. Berwick takes a lot of flack from opponents of health care rationing for praising the British health care system, but he was instrumental in the process improvement epiphany of the American system.

Long before the damning 1999 report on Medical Errors shocked the medical community out of its complacency, Berwick, former chief executive officer of the nonprofit Institute for Healthcare Improvement, was making the quality improvement case that has helped guide local providers.

The addition of continuous improvement evangelists like Jim Woodward (Meriter Health Services) and Frank Byrne (St. Mary's Hospital) hasn't hurt, either.

Last fall, as I gathered information from local insurers about projected 2011 premiums, it struck me just how unique this area is. Unlike other regions, Madison will see very modest premium increases this year, largely due to steps already taken that are well aligned with the new health care law.

It's anyone's guess as to whether the battle over ObamaCare will result in a better health care system, but Madison's health care industry is proof that no region needs government to take the lead.

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