Richard Gilfillan had an important question to ask those that attended his lecture at Chautauqua Institution on Wednesday morning.
If a group of people were brought together to create a society, but nobody knew what their status in that society would be, would they create a health care system that left 20 percent of the population without access to care?
"Would you even consider it if you were sitting in that room, not knowing if you would be covered or not?" Gilfillan asked.
Richard Gilfillan, former director of the Center for Medicare & Medicaid Innovation, speaks at Chautauqua Institution on Wednesday about health care reform in the United States and how the social contract surrounding it must be redefined in the coming years.
P-J photo by Ryan Atkins
Gilfillan, who stepped down in June as director of the Center for Medicare & Medicaid Innovation at the Centers for Medicare & Medicaid Services, spoke at length during his lecture about the Affordable Care Act, the reforms that are taking place, and what to expect in the future. In his role as director, he worked with CMS leadership to develop and implement innovative programs to help improve and update the nation's health care delivery systems.
"Everything about delivery system change has to result in three things," Gilfillan said. "Better health, better care and lower cost. We know now that you can do all three."
In 2008, at the height of the economic recession, 16 percent of the population of the United States was without health care. Those who did have coverage were locked in with their providers. If they had a pre-existing condition and they lost their coverage, buying insurance on the individual market was extremely difficult, often resulting in a much higher rate.
"We should say that a great health care system should deliver those three goals for its entire population," Gilfillan said. "In 2008, for life expectancy overall, (the U.S.) was 33rd overall, right before Cuba. Life expectancy over age 65 was still in the lowest quartile internationally. Patient safety in hospitals had not progressed significantly. There were some high points though. We were at the top in terms of mortality after you turned 85. Getting there, not so good."
According to Gilfillan, at that time, the majority of patients were not satisfied with their health care and saw the need for it to be rebuilt from the ground up. Additionally, many health care providers and states also saw the need for reforms.
"We had states going through the recession suddenly realizing that their health care costs were underfunded in massive ways," Gilfillan said. "Even today we're facing that problem. On top of that, we have this epidemic of chronic disease that is driving costs in a system that is primarily focused on treating recurring illness. That's what we were facing in 2008; it was a perfect storm."
After speaking about where the recession had left the United States in terms of health care, he then went on to outline the basic tenets of the Affordable Care Act, and how it can help the situation that the country is faced with.
"Things are changing in the health care system," Gilfillan said. "Are we on the tipping point? I'd like to think so. Change is hard, though. Everyone is living in the right now, but they need to believe that there's a viable future. You can help. What you can do is understand the issues, support enrollment this fall, encourage your providers to transform and take action in the community."
The ACA included initiatives to help drive this transformation, as well, but according to Gilfillan, it will have difficulty succeeding without effort from all sides.
"Every so often, we rewrite the social contract in response to a social crisis," Gilfillan said. "It happened in the 1940s, 1960s, 1980s - we created major changes in the social contract and what we expected from each other. I think that this is one of those times. Obamacare is a public-private, marketplace-driven approach to meet the challenges that we face. It's a new approach that brings together the market and the state and federal governments to build on all that we've learned. It will impact our lives and those of Americans for years to come, and leave for our children this great gift of a future where they have excellent health care, a vibrant economy and, I think, a new democracy with a social contract that guarantees health care for all."