Early Diagnoses of the New Law

March 29, 2010 The New York Times

Love it or hate it, the health care overhaul is the most significant piece of domestic legislation to emerge from Washington in decades. The new law is also ferociously complex: the original Senate bill, which served as the blueprint for most of the changes, ran well over 2,000 pages.

So what is buried in those pages? Here are some thoughts from health care experts on what the changes will mean for Americans, sick and well alike.

Elizabeth A. McGlynn

Associate director of health programs, RAND Corporation.

Can the health care system handle the demands of 30 million-plus new customers?

It's estimated that more than half of the newly insured will be under age 35, and about 80 percent will be in good to excellent health. They will not be using services for the first time, but they may decide to change providers. More than one-third will enroll in Medicaid, and it's thought they will use fewer services than those with private insurance.

Still, in the short run, the capacity of the system to meet demand will be strained, particularly in areas that currently have high rates of uninsurance.

Consumers shouldn't be surprised to find a system in flux as we look for new ways to deliver health care. Patients might see a nurse practitioner instead of a doctor for routine problems; they might confer with their doctor over secure Web sites or their cellphones. We're likely to see health care delivered in ways we've never seen before.

Brian D. Smedley

Vice president and director, Health Policy Institute at the Joint Center for Political and Economic Studies.

The dramatic passage of health care reform was a historic turning point in the effort to repair a deeply broken system. But by itself, the legislation will not be enough to address the needs of many people of color, who face higher rates of infant mortality, chronic disease and disability, and premature death than white Americans do.

The new law will help expand insurance coverage and improve access to health care providers in underserved communities, among other benefits. But the major reasons for the persistence of racial and ethnic health inequalities are socioeconomic inequality and differences in neighborhood living conditions - both of them fueled by residential segregation. These are the issues that policymakers must tackle if we are to improve opportunities for good health for all.