The Affordable Care Act is the law of the land and will not be repealed by the next President. In spite of this the people with their heads up their dark places are still trying to circumvent it. What is your alternative? Without a clearly defined alternative the only option seems to be that we stick with the current system.

The system as currently constituted seems to work well. However with close objective examination it does not. The rate of cost growth is faster than inflation and is ultimately unsustainable. The quality of the system seems great only if it is not compared with a similar system. I must admit that for some it is truly the best. However for most it is a mediocre system.

For those with chronic disease the system is poor at best. If you are an African-American no matter your economic status you know that the system is very poor. The worse part of the current and next system is that quality is not a meaningful part of the discussion. The whole discussion is about cost. I contend that the discussion should be about quality first. My postulate is, if quality evidence based care is provided cost will be manageable and sustainable. What constitutes quality care is not the question. The only question is, can we align the system to pay for the delivery of quality care not quantity of care.


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