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Build on health reform's strengths, improve weaknesses

At the risk of having my membership in the Republican Party revoked, I believe there are a lot of positives in President Obama's health care reform law, and that logical members of my party should leverage those strengths to fix a system everyone agrees is fatally flawed.

I have spent a career leading large health care organizations, have seen our current system close-up every day for the past 20 years, and the Patient Protection and Affordable Care Act is the most promising systematic fix that I have seen to begin to cure the ills of our health care system.

No one can dispute that the current system we have is expensive and broken. We spend 17 percent of our GDP on health care, more than any other country in the world, and the cost curve is growing and unsustainable. The inefficiency of our health care system is at the heart of our national debt problem, stealing resources from other critical needs like education, research and development, and infrastructure.

At the same time, our quality outcomes are middling at best, with levels of infant mortality, life expectancy and chronic disease incidence that do not compare favorably with much of the developed world.

The problems of the 40 million to 50 million uninsured in this country are well-documented. The inefficiency of having a hospital emergency room as the primary access point for many uninsured is obvious to all of us. The costs of defensive medicine, redundant testing and inappropriate care have all been well-documented. The problem will magnify as 10,000 new baby boomers join the Medicare system every day for the next decade.

Here are a few of the features in the Affordable Care Act that this economic conservative finds appealing:

The individual mandate: As any insurance professional will tell you, effective management of a risk pool requires that all individuals participate. You cannot provide fire insurance only to people whose homes are already burning, and similarly, you cannot provide health insurance only to the sick. People who don't need insurance fund the people who do -- that is the way the insurance industry works.

Accountable care organizations: One of the most fundamental flaws with the current system is the focus on short-term health events, which is caused by our fee-for-service payment structure. Health care is a long-term, lifelong proposition, and our system needs to take a long-term, preventative perspective in both care delivery and reimbursement. ACOs make a coalition of health care providers responsible for the overall health and care of a population, aligning economic incentives and the needs of the patients. They represent an important step away from the totally ineffective way health care is delivered and reimbursed today.

Electronic records and health information exchanges: While the incentives for installing electronic health records are technically part of the Health Information Technology for Economic and Clinical Health (HITECH) Act that preceded the health reform bill, the Affordable Care Act will serve to continue their development. Managing the health of a population over the long term requires long-term, meaningful outcome measurement that can be readily accessed and shared among care providers.

The first electronic health record was developed more than 40 years ago, at the dawn of the information age, and the incentives provided by the recent legislation have provided the economic stimulus to finally get this critical information infrastructure moving toward reality.

Health insurance exchanges for individuals: Have you ever tried to purchase health insurance on your own? If you have, you likely found it an expensive, befuddling process. There is a good reason for that: the vast majority of health coverage in this country is purchased by employers, and health plans develop their products for what is essentially a wholesale marketplace. The new state exchanges proposed in the Affordable Care Act have the potential of revolutionizing the health insurance industry by making this fundamental product available in the retail marketplace. Can you imagine understandable, consumer-friendly health insurance products being marketed by companies who are really sensitive to the needs of individual consumers?

Are there flaws in the plan? Of course there are. It is overly bureaucratic and confusing in a lot of ways. It will still allow up to 20 million people to go uninsured. The employer mandate penalties are going to create an incentive for many businesses to abandon their health insurance plans. Big problems don't get solved with big, sweeping solutions; it is typically a more gradual process. The Affordable Care Act is a start, and we should build on its strengths and continue to improve on its weaknesses.

Will it happen? With the partisan rancor that passes for contemporary politics, I have my doubts. But I would ask my Republican colleagues to think long and hard before they reject this attempt to fix a generational problem. Going backward to the current hopelessly broken system should not be an option.

Larry Zielinski, of Elma, is a former president of Buffalo General Hospital and the Visiting Nursing Association of Western New York, and currently a consultant with Murak & Associates.