We’re days away from answering one of the major questions hanging over the country: whether we continue with the process put in place by the Affordable Care Act, or go back to the drawing board for health-care reform.

Summa Health System CEO Thomas Strauss dove into that question in a meeting with state and national health policy experts Wednesday in Akron.

“I think everyone’s beginning to realize that healthcare in this country is unsustainable.  We’re bankrupting the country with what we’re spending on healthcare today.  Two-and-a-half trillion dollars we spend on healthcare, that’s almost 18-percent of GDP, and if we don’t do something shortly it will be unsustainable.”

Strauss says the Affordable Care Act will bring down costs by replacing the piecemeal billing of the current system, or a ‘fee for service’ model, to one that rewards keeping people healthy.

“And that’s really under the Affordable Care Act, in this past year we've implemented accountable care components, moving away from fee for service to these areas of values-based payment."

Political analyst David Gergen told the forum that the Democrats alienated Republicans by leaving them out of key discussions leading up to the Affordable Care Act in 2010.  He says the passage without Republican support leaves the overhaul in limbo.

For example, much of the future funding for the bill will have to pass the Republican-controlled House, and Gergen says a close election won’t provide the mandate the president needs to press forward with ‘Obamacare.’

“He’s not going to have the leverage coming out of this election --  it’s basically a 50/50 election. It’s hard to tell people that the country spoke with a clear voice.”

But Gergen says, it may not matter who wins the presidential election.

“Because the struggle to provide access, quality, at an affordable cost will continue regardless, and much of the progress will happen at the local and state level; it just has to be.”

Greg Moody is the person Gov. John Kasich tapped to overhaul the state’s healthcare priorities.  He’s head of the Office of Health Transformation, what Moody calls a temporary strike force with a mission to modernize Medicaid, streamline the departments of Aging and Health and Human Services, and improve the overall performance of the state health system.

“For 18 months now, we’ve focused on a set of strategies for Ohio that we think can improve care and control costs. Some of those have their authority in the ACA, but we have the authority on our own to go ahead and act.”

Moody isn’t saying what those changes will be.  He says the U.S. Supreme Court ruling on healthcare this summer gave states like Ohio the choice of whether to expand Medicaid coverage to low-income people who don’t now qualify. And Ohio has not yet decided what to do.

“Our goal is affordable coverage for every Ohioan.  One option would be to expand Medicaid to cover that group, but we’re looking at other options as well.” 

And Moody says those details will be revealed with the governor’s budget next February, well after the winner of next week’s election is inaugurated and ready to pick up America’s perennial political football, healthcare.