Expanding patient access to effective and affordable health care is an admirable goal, but successfully doing that requires 3 elements—that access be expanded, and that the health care be both effective and affordable. Consider the following scenario, in which affordability is provided under federal law, but the effectiveness of care is very much in question.

Negative Reinforcement

Gwen provides early intervention (EI) physical therapist services at Bright Start, a small multidisciplinary agency. Although she'd more or less stumbled into the job early in her career, she's now been a physical therapist (PT) at Bright Start for more than 20 years and can't imagine anything more rewarding than helping children younger than 3 years old who are experiencing or are at risk for developmental delays. She feels privileged to have played a role in improving the lives of many children—enhancing their immediate quality of life and working with families, caregivers, and her Bright Start colleagues to better ensure their long-term prospects.