The Affordable Care Act – Good, Bad, or What’s the Difference?


Mark's Note: I'm away on vacation through November 6… there will be some guest posts in this post during that time. Today's post is by Dean Bliss, a good friend of mine who has worked in Lean healthcare for a long time now, in many different capacities.

deanblissIn my work in Lean healthcare over the past few years, one question that I am frequently asked is “what do you think about the Affordable Care Act (a.k.a. ObamaCare)?”   I have my own opinions of the pluses and minuses of the ACA, whether it is the individual mandate, the funding sources, the impact on insurance, or any other items.   But my response to the question is always the same: “It doesn't matter.   It's the law, and we have to deal with it.”

The ACA is having a profound impact on many aspects of healthcare, and where we are in 2013 is just the tip of the iceberg.   Increased demands on the system, confusion about the rules, and the uncertainty of the political landscape are all significant factors in what happens going forward.   But here's the deal – we in healthcare have work to do no matter what happens.

Many healthcare organizations, including hospitals, clinics, and health systems are scrambling to figure out how to continue to provide quality care with the potential of declining revenues and resources.   Some are reorganizing, others are cutting services, still others are closing.

Many are looking to continuous improvement techniques (Lean, Six Sigma, ISO) to give them the ability to compete.   Some of these things will work – others will not.   It behooves us to keep an eye on all these reactions to see how they play out.

My bias, as someone who's been on the inside of the healthcare system, is to advise healthcare organizations to use proven improvement philosophies, tools, and techniques to get better at what we do.   It's something that's within our control, as opposed to the labyrinth that is the ACA.

We need to take the waste out of the processes we use, improve the quality of our care and our services, and find ways to keep our employees and colleagues satisfied and productive.   Thinking about ways to do things better every single day – and implementing those new ways – can move us in that direction.   But we need to get started.   And the best time to start is now.

Will ObamaCare survive?   We don't know.   But whether is does or doesn't, it really doesn't matter.   We still have to provide healthcare to our communities.   And we have to do it the best we can.

What is your organization expecting in 2014? How is this being communicated to your staff (or is it)? What plans are in place based on what your organization expects?

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Dean Bliss
Dean Bliss is a now-retired Lean healthcare practitioner.


  1. Whether the ACA is good or not is a matter of perspective. A senior leader in my organization making several hundred thousand dollars a year said it was a good thing because now his graduate student child is covered on his policy to age 26.

    From my perspective the fundamental problem is that we are spending too much money as a society on healthcare. The reality is that the types of waste normally addressed through Lean are only a small part of the excessive waste and cost in our healthcare system and the ACA has little focus with reducing overall costs. Some will debate this but we will just have to wait and see.

  2. If healthcare isn’t actually going to be more Affordable under the “Affordable Care Act” (where is the promised $2500 per family savings?), what does the A stand for?

    Acceptable (as in coverage that is better?)

    Will we have to pass an “Available Care Act” to resolve physician shortages that will get worse with more people getting into Medicaid?


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