The State of the Union Address: What the President Got Right on Healthcare


January 30, 2014

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Hello and welcome. I am Dr. George Lundberg, and this is At Large at Medscape.

The Affordable Care Act, also known as the ACA or Obamacare, is a vast, complicated, ambitious, and audacious multipart social and economic experiment, unprecedented in prospectively created interdigitating complexities.

In his 2014 State of the Union address on Tuesday, President Obama chose to say little about health or healthcare. He did note some improvement in the slowing of the obesity epidemic.

He did not allude to the well-known glitches in the rollout of the ACA's federal insurance exchange Website,, but he did celebrate that roughly 12 million additional Americans now have health insurance -- people who would not have had insurance without the ACA. The focus was mostly on new access via insurance and prevention of personal bankruptcies.

How likely is a fully implemented ACA to succeed in a historical perspective?

I have graded the US healthcare system across 11 parameters since 1992. These data have been published for various years in JAMA, the Medscape Journal of Medicine, and on MedPage Today.

The desired parameters are:

1. Provides access to basic care for all

2. Produces real cost control

3. Promotes continuing quality and safety

4. Reduces administrative hassle and cost

5. Enhances disease prevention

6. Encourages primary care

7. Considers long-term care

8. Provides necessary patient autonomy

9. Safeguards physician autonomy

10. Limits professional liability

11. Possesses staying power

A perfect score for each parameter is 9. A perfect score for the overall system would be 9 times 11, or 99.


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