Does the Affordable Care Act give the American people what they want?

Now here’s a novel idea. What if someone asked the American people, or a demographically representative group of it, what it wants from healthcare. That would be called “market research.”

Ask the public what it wants, listen carefully, and then give it to them.

Turns out that the New York-based Commonwealth Fund has done just that.

In brief they found:

  • 72% of American adults believe that our healthcare system needs to be fundamentally changed or completely rebuilt.
  • 71% have experienced difficulty in accessing a doctor without having to go to an emergency room, especially any time other than Monday through Friday, 8 to 5; 55% report wasteful poorly coordinated care; and 21% reported having experienced a medical error in the past two years.
  • 96% want accessible, coordinated, well-informed care; 94% want a medical home; 86% want doctors and nurses to work as teams; 92% want information technology applied to healthcare; and 57% want Internet access to their records and email communication with their physicians.
  • 75% expressed worry about their own future healthcare.
  • And, 86% believe that prices for all aspects of medical care including products and services should be negotiated by public and private payers to control costs and improve quality.

These results are remarkably uniformly spread across income and education levels, geographic regions, and political affiliations.

The problems cited are real and damning.

The wish list is what any sensible person would expect, especially for the kind of money that we spend.

The systematic incompetence of healthcare as experienced by “the market,” would not be tolerated by the public from the airline industry, automobile manufacturers, computer companies, restaurant chains, clothing manufacturers and sales, not even from cable TV or cell phone companies.

We in healthcare should be ashamed of ourselves.

The Affordable Care Act (ACA) does address many, but not all of these issues, either directly or in pilot programs.

The problem is that even if the ACA is not found unconstitutional by the highest court, or unfunded by a hostile Congress, its full rollout is still at least three years away.

I believe that this prolonged delay to full implementation will be found by historians to have been the fatal flaw in its construct.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit for more health policy news.

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