Hopkins supports health care reform

March 17, 2010

We are hitting two important milestones this month: the one-year anniversary of the official introduction of the House of Representatives health care bill and the awaited passage of comprehensive health care reform legislation.

Now, as this exhaustive debate reaches its conclusion, we look back a year, and back 120 years to our founding principles. And hence, we at Johns Hopkins Medicine believe we're affirming a core belief in supporting passage of HR 3590, the Senate's health care reform bill, as well as accompanying legislation that is expected to take the form of a reconciliation bill.

We at Johns Hopkins have worked long and hard to advocate in the legislative arena, meeting with dozens of senior legislative and executive branch officials. But the fact is, we have not prevailed on securing some of our priorities. We sought to safeguard disproportionate share payments until we could be assured that the coverage expansions would insure the vast majority of the people we serve. We did not want the legislation to include an independent payment advisory board because of the potential unintended consequences for hospitals and our patients. We wanted the reform legislation to increase Medicare-funded graduate medical education slots. We also shared our views extensively on the subjects of geographic variation, value indexing, and readmissions. We also remain concerned about the rapid expansion of Medicaid, which could severely strain parts of our current health system.

However, we applaud the Senate bill's designation of the Healthcare Innovation Zone pilot, which can integrate healthcare providers, align their incentives, and help reduce health care costs for a geographically defined population of patients. The formation of the Center for Innovation within the Centers for Medicare and Medicaid Services can help providers in designing programs that coordinate care and move us away from the current fee-for-service reimbursement model focused on rewarding volume.

Now time is up. We know that if the Senate version fails to pass in the House of Representatives, our concerns become irrelevant and the central issue of the uninsured will remain unaddressed. It may then be a very long time before our leaders in Washington are willing once again to take up the challenges facing our health care system.

We believe that a vote for passage will finally bring us closer to the reality of expanding coverage to 30 million people Americans presently without insurance. We are at a point at which the inequities and injustices of a system that leaves tens of millions of Americans without health insurance are no longer acceptable. These types of inequities that led to the founding of Johns Hopkins Hospital, and our decision today mirrors the mission bequeathed to us more than a century ago.

Dr. Edward Miller, Baltimore

The writer is CEO of Johns Hopkins Medicine and dean of the Johns Hopkins University School of Medicine.

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