No matter how the Supreme Court rules on the health care reform law, the nation's health system must radically change to control costs and improve quality.
And while the federal government can set the stage for those changes, many of the details will ultimately be worked out on the local level as communities search for solutions that fit their particular needs.
Those are two of the insights offered by Dr. Michael W. Cropp, president and chief executive officer of health insurer Independent Health, who spoke Thursday to the Rotary Club of Buffalo in Templeton Landing.
Cropp describes the Patient Protection and Affordable Care Act as a good first step toward increasing access to primary care, improving quality and better controlling costs.
He said some of the law's provisions already in effect have been positive, such as extending the age limit to 26 for dependent coverage, making health insurance available to children with pre-existing conditions and helping seniors pay for prescription drugs through the Medicare Part D coverage gap.
"The law will allow us to build upon it to make changes that best fit each community," he said.
Cropp said the law also includes provisions to confront the skyrocketing cost of care and the increasing share of household income that it consumes.
Among other things, he noted that the law makes investments to establish best-practice standards in medicine and to move payment for health care toward rewarding quality rather than quantity of care.
However, he said the nation shouldn't expect the health care system alone to magically solve the cost problem.
"It's a collective responsibility. The problem is bigger than any one of us," he said, estimating that 75 percent of current health costs relate to chronic diseases that often arise or worsen because of lifestyle choices.
These include the links between cigarette smoking, overeating and lack of physical activity and such ailments as heart disease and diabetes.
Cropp cited five major areas for change to improve quality, access and affordability of health care locally and nationally:
*Place more emphasis on prevention of chronic diseases.
*Reform payment systems to reward quality and more convenience to patients.
*Revitalize primary care to improve coordination of care.
*Eliminate care that is redundant or adds no value, and encourage care based on what the scientific literature says is best.
*Enhance the health information system to accelerate adoption of electronic medical records.
"We have created a monstrosity of a health system that is overly complex," he said.
But Cropp praised efforts in Western New York in some areas, such as HEALTHeLINK, an initiative to streamline medical records here that is considered a national leader in health care information technology.
"In the next steps in health reform, it almost doesn't matter what the Supreme Court decides," Cropp said. "We have to act as a community to drive inefficiency out of the system."