Concerns presented by the new health legislation

The 2010 health care reform legislation is a landmark redesign of the nation's health system that will have profound implications and also raises considerable concerns, especially for patients with chronic or serious diseases and those who treat them.The legislation uses a centralized "administrative state" approach, rather than approaches built on correcting features of the current system, spurring federalism, or moving to a single-payer system. This involves adding a new layer of boards and programs onto the existing system.Existing arrangements will be disrupted. Millions of Americans will find their employer-sponsored insurance is replaced by coverage through new health exchanges or Medicaid. There will be improvements as a result of this for many, but others will find that their access to physicians and therapies becomes more limited.The legislation will encourage or require tighter practice guidelines intended to improve quality and pay-for-performance. A problem is that under the administrative state approach, the strategy will involve more restrictions on physician practice based on centralized interpretations of quality and effectiveness.Spending on health care will grow, and anticipated savings are not likely to be fully realized. This will increase future pressure for cost control. The likely result will be a form of rationing, which includes further tightening of practice guidelines and payments increasingly tied to the federal government's determination of quality and what constitutes essential services.