Which is worse? The Republican determination to kill the Affordable Care Act or the Democrats’ insistence that health reform is now settled? Neither position serves this industry particularly well. By reducing the debate to the polemics they have, the parties are merely continuing to distract the voting public—who largely remain in a state of gleeful denial about the seriousness of the health and related financial issues facing the nation.

At the recent Health Care Financial Management Association conference (which ended the day before the Supreme Court upheld the health reform law), I heard multiple industry leaders sound a similar refrain: what the Supreme Court does or does not do is largely irrelevant. By that they meant, regardless of the legal status of the law, the industry must reduce the cost of care and do it soon. Industry leaders know they must reduce their own operating expenses and control the costs of their most expensive patients. And they know they must do a better job of coordinating care for them. They know they face diminished financial support from payers of all varieties, not only Medicare—for whom insolvency looms—and Medicaid, from which some states are starting to flee.

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