Good, affordable health care for all: How long will it take?

With last week’s Supreme Court ruling on health reform, many at Group Health Research Institute (GHRI) felt relieved. The decision to uphold most of the Affordable Care Act (ACA) should put our country on a straighter path toward improving access, affordability, and quality for all—imperatives in our Institute’s mission.

Still, we live with great uncertainty. How will the ACA affect the business of health care? What will the fall elections mean for health care policy? What’s the future of research funding, given shaky economies here and abroad? How will the federal budget impact jobs at GHRI and elsewhere?

Answers will emerge over time, but not knowing can be unsettling. In times of hardship and uncertainty, it’s natural to wonder: How will this all turn out?

Taking the long view can help. My friend Dr. Steven Schroeder of the University of California, San Francisco reminded me of this with his speech to the Society of General Internal Medicine (SGIM) in May. He reflected on several recent assaults to scientific integrity, care for the disadvantaged, and other values most doctors hold dear. Despite grim evidence, he insisted, “Hope is still alive.” He’s seen it in many places: Advances in public health; civil rights; treatment for AIDS; his medical students’ idealism. To them, he quotes Dr. Martin Luther King: “I know you are asking today, ‘How long will it take?’… Not long, because the arc of the moral universe is long, but it bends toward justice.”

So how long will it take to achieve GHRI’s mission “to improve health and health care for all”? You could say, “not long”—because improvement is incremental and we work at it every day.  Looking back, we see the arc clearly: in 1947 when Group Health was established by labor unions, Grange farmers, and local activists “to serve the greatest number.” During 1950s McCarthyism, when Group Health won a legal battle with the King County Medical Society, over claims the Cooperative was un-American. And through the 1960s, when it overcame racism to integrate its medical staff.

Amidst challenges, Group Health has grown in numbers and influence. With GHRI’s founding in 1983, it began to rigorously study its population’s health, sharing discoveries globally. As this chart shows, the Institute’s work on prevention, cancer screening, vaccines, chronic illness care, primary care design, and more has been translated into better care for Group Health members and others nationwide.

Now, with the ACA upheld, our work as a learning health care system could not be more relevant. A recent example: The University of Chicago’s study in the Journal of the American Medical Association (JAMA) last week linked the patient-centered medical home (PCMH) model to higher costs at 669 federally funded community health centers. This is an important contrast to GHRI’s 2010 evaluation of Group Health’s PCMH pilot. With colleagues, Dr. Rob Reid, Group Health’s associate medical director for research translation, found that Group Health recouped its PCMH investment through savings in emergency and hospital care. In an invited JAMA editorial, Rob and I explained that practices in the University of Chicago study could not claim such savings because, unlike organizations like Group Health, their medical homes aren’t integrated with emergency and inpatient care. And we stressed that primary care practices cannot achieve the promise of the PCMH—improved care, lower costs, and higher patient and provider satisfaction—without strong financial support.

Translating such knowledge into better care won’t come easy. In his speech to SGIM, Steve Schroeder offered six suggestions for making a lasting difference in the dynamic times ahead.

1. Work on things that are important to you.
2. Be reliable.
3. Model your values.
4. Avoid the false dichotomy of having to choose between professional and personal satisfaction.
5. Be resilient.
6. And believe that the arc of history can be bent toward justice.

By following his advice, perhaps we can join the force that makes it so.

—Eric