Could Physicians Take the Lead in Health Reform?

Relman examines whether physicians can take the lead in health care reform. Physicians have a key role in reforming US medical care. The fundamental problem with the health care system is its high, uncontrollable cost, and that cost is largely determined by the elective decisions of physicians to use medical resources. Health policy experts increasingly suggest that controlling these physician-generated costs will require a change from fee-for-service to some type of global payment, and the formation of accountable care organizations (ACOs) in which integrated multispecialty groups of physicians will be able to share global payments with hospitals and other providers. In March 2010, Congress passed the Patient Protection and Affordable Care Act, which greatly extended public and private insurance coverage but did not replace fee-for- service payment or change the organization of medical practice. The act does provide support for trials of ACOs and for experiments with improving fee-for-service payments but most physicians are not organized or ready for ACOs, and Congress is unlikely to mandate the general use of global payments for government programs anytime soon. How- ever, without waiting for new legislation, physicians could begin a transition to a major change in medical practice needed to save the imperiled US health care system.