The Great American Clinical Trial…why the Supreme Court won’t end healthcare reform

Enormous attention has been paid to the Supreme Court review of Healthcare Reform, known as the Affordable Care Act (ACA). You’d think the entire reform effort hinges on the decision of a court divided along ideological lines. Welcome to politics and news reporting.

There is a background detail that rarely gets mentioned. Perhaps it isn’t as sexy as Democrats vs. Republicans. It could also be that the news organizations ignore the details in favor of the emotions. Whatever the cause, there is a key fact missing in the debate…economic stimulus spending was passed by Congress in the throes of the Great Recession and allowed doctors and hospitals to be paid to set up electronic medical record systems. I’ve heard estimates as high as $100,000 per doctor in payments (though this isn’t necessarily the full cost).

Outcomes

In effect, we’ve created something brand new that makes every patient of every doctor a potential member of the Great American Clinical Trial. When I say ‘potential’, it’s because having electronic medical records in many systems around the country isn’t by itself the idea. The Clinical Trial begins when we consolidate those records and have a view of all disease, all treatment, and what works and what doesn’t.

If that doesn’t sound too important, consider the graphic below. This was provided by the Commonwealth Fund and represents the performance of healthcare systems around the US. The disparity is alarming, and the detail within the article is worse than the graphic.