Even with “ObamaCare” Upheld, Much Hard Work Remains to Protect Patients and Make Care Affordable


The Supreme Court has mainly upheld the Patient Protection and Affordable Care Act, including the individual mandate and other controversial provisions. The court did not throw out the entire law. Congress can no longer penalize states for not expanding Medicaid eligibility.

Putting personal political preferences aside… as Lean professionals or quality improvement people, should our reaction be “so what?”

The intro to an op-ed I've written and submitted begins like this:

Even with this week's Supreme Court ruling that upheld most provisions of the 2010 law, hospitals and health systems around the country will have to continue, if not accelerate, their improvement efforts that started well before the passage of the Patient Protection and Affordable Care Act.  These practical changes, driven by proven systems engineering and management principles, often referred to as “Lean thinking,” will continue making care safer and less expensive, regardless of what happens in our nation's capital.

View or download the full op-ed as a PDF.

We can continue watching the news… or we can roll up our sleeves and get back to work.

What actions are you and your organization taking this week to make patient care safer and less harmful? What are you doing to make care affordable?

There's a lots of work to do… I don't think we can legislate real efficiency and quality.

Does this decision change the future course for your hospital? What are you hearing from your senior leaders?

What do you think? Please scroll down (or click) to post a comment. Or please share the post with your thoughts on LinkedIn – and follow me or connect with me there.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Henry Ford Health System CEO reacts:


    “Henry Ford has been a national leader by demonstrating a strong and continued commitment to improving care and reducing costs. Its No Harm Campaign, which started before passage of the Affordable Care Act, has resulted in a 31 percent reduction in harm events and 12 percent reduction in mortality over a three-year period. By comparison, the average reduction in harm events is roughly 1 percent to 2 percent per year in most U.S. hospitals.”

  2. From the American Hospital Association head:

    “But transforming the delivery of healthcare will take much more than the strike of a gavel or stroke of a pen,” American Hospital Association President and CEO Richard Umbdenstock said in written statement. “It calls for the entire healthcare community to continue to work together, along with patients and purchasers, to implement better coordinated, high-quality care.”


  3. Another CEO perspective:


    “As a health care leader I obviously support every American having access to health care insurance,” said Carroll Hospital Center President and CEO John Sernulka. “The way I view it, the original law and now reaffirmation by the Supreme Court is a major catalyst towards recognizing that the health care system in America is too costly and is too fragmented and is not working.”

  4. A more skeptical CEO view:

    Some executives also remain skeptical that the influx of paying patients will materialize. “The tax for not having health insurance is so small” that many may choose to go uninsured, said Barry Arbuckle, chief executive of MemorialCare Health System, which runs six Southern California nonprofit hospitals.



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