The stark white page shows an official time stamp of March 23, 2010, and the choppy signature of President Obama, who had to use the 22 pens he would later gift each member of the House and Senate who helped him pass the landmark health-care law.
“We thought it would be pretty simple,” Kocher recalled with a grin. “We had 60 Democrats in the Senate and a huge majority in the House, a popular president. But then you saw what happened.”
Kocher was the keynote speaker at last week's Health Policy through 2020: The ACA, Payment Reform and Global Challenges, a half-day symposium of speakers and panels covering some of the greatest challenges facing health care and policy here at home and abroad.
“Everything that you could imagine would throw a monkey wrench into it, did,” said Kocher, a physician and partner at the Silicon Valley venture capital firm Venrock, which invests in health-care and technology startups.
Now, six years after its rocky start — and ongoing threats by Republicans for its repeal — Kocher still believes the ACA has had a tremendous impact on the nation.
“Despite the single worst launch of a website in the history of the internet… 20 million more people have access to health care,” he said. “I believe the ACA is working better than expected by virtue of the fact that there’s nobody in the ecosystem who is not behaving differently.”
Large employers have been forced to engage with their employees about the costs and quality of their health plans, and hospitals are adopting new technology by “liberating their data” with electronic medical records and embracing telemedicine, Kocher said.
“And for the first time, you see patients beginning to engage with new technologies and their doctors willing to entertain new models.”
Kocher, a consulting professor at Stanford Medicine, was one of 15 speakers at the symposium to launch Stanford Health Policy, a community of faculty, physicians, scholars and students focused on improving health care and policy worldwide.
During the symposium, Stanford School of Medicine Dean Lloyd Minor, MD, shared what he called “some surprising statistics." When looking at a pie chart representing the determinants of health, only 5 percent are genetically based, 20 percent are based on health care and another 20 percent are due to behavioral factors.
But a full 55 percent of the determinants of health are socially and environmentally determined, Minor said -- and that presents challenges for academic medical centers.
“I’m really excited in that I believe that we are beginning to come up with some ways we can address that need, as a leading academic medical center, to chart the future for how we can improve the delivery of health care in our country and then ultimately around the world,” Minor said. “For us, that vision for how we fulfill that need, begins with what we describe as precision health.”
Minor said precision health is about using genomics, big data science and personalization in order to individualize the treatment of acute diseases such as cancer, heart and neurological diseases.
“It’s about understanding the determinants and predisposing factors of disease in being able to more effectively intervene earlier,” he said. “And of course there’s no better place to do that than at Stanford because our academic medical center is such an integral part of this great research university.”
Previously: Stanford Health Policy symposium to address future of health care in U.S. and abroad, Supreme Court upholds Affordable Care Act with a 6-3 vote, Finding the heart of precision health and Aim higher: Dean Lloyd Minor calls for widespread embrace of precision health
Photos, including top one of Bob Kocher, courtesy of Stanford Health Policy