As a physician, I will share with you what I do and don’t like about the ACA.
First of all, the positives: The ACA provided access to millions of Americans who had no previous health insurance. This largely ended the practice of using the Emergency Room casually as a primary care provider. There are big problems with overuse of ERs. The patients are often indigent and cannot ever pay the medical bills; ER fees run as much as 4-5 times the cost of a daytime visit to one’s PCP. So who pays for them? You and I. Unpaid medical bills lead to bankruptcies for patients and increased medical premiums for everyone. You didn’t think the for-profit hospital was going to write these losses off as charity, did you? LOL.
The other major problem is one which points to the real human costs of not having insurance: delayed diagnosis. Conditions which could have been curable are diagnosed too late. There is no way to quantify the costs of the loss of a family member to his or her family and community.
Since the ACA provides subsidies that work on a sliding scale to help low-and-middle income people buy a policy, these subsidies allows them to have extra funds for other exigent needs such as food and shelter.
The ACA provides coverage for children under the CHIP program covering vaccines and other care for kids. If the GOP’s AHCA uninsures $24 million human beings, most of them are going to be children.
The ACA eliminated pre-existing condition clauses. This leveled the field and let chronically-ill patients get insurance at affordable rates.
The allowance permits adult children to remain on an ACA-sponsored plan through age 26. This eliminated the need for college kids to have to procure separate policies. It also eliminates life-time caps on medical expenditures/person.
Now, some negatives. Despite pleas from doctors and patients, nothing is written into the ACA that assures a patient can maintain their physician as they transition from one ACA policy to another. Disrupting the doctor-patient relationship just results in duplicated tests, poor communication among providers, and unhappy doctors and patients. At a New Yorker Festival event, I stood and asked Nancy Pelosi if she was going to guarantee that the then-new ACA would protect the doctor-patient relationship. She told me it would, and I am still disappointed.
The burden of paperwork on medical care providers is tremendous and unnecessary. It stems not just from the ACA, but from previous legislation aimed at transitioning providers to electronic medical record systems. This increased burden of administrative, non-clinical duties has decreased the time providers spend with patients — a further erosion of the doctor-patient relationship.
There was no public option offered. If there had been, we might have seen proof by now of what we all suspect: a one-payer system would eliminate duplicated administrative tasks, over-paid for-profit administrators and insurance CEOs, and annoyances like multiple drug formularies. Below is a chart of 2014 Health Insurance Company CEO salaries. Note the 66.1 million dollars earned by Stephen Hemsley of United Healthcare.
We are now so entrenched in our for-profit healthcare system that trying to transition to a one-payer, not-for-profit system would unemploy potentially millions of people, or displace them from their usual occupations. This is one of the complexities that the current administration just didn’t get, when Trump lied about being able to provide “healthcare for all at an affordable price.” Yes, Donald, it IS complicated.
One of the contradictions of the American character seems to be that some still don’t believe that health care is a right, but this very denial actually leads indirectly to spiraling costs. In societies which believe that healthcare is a right, life-long health care is provided with minimal administrative costs. Government-sponsored programs such as Medicare have an administrative cost of around 3-5%. Insurance-run health programs, however, have a much higher administrative cost because people need to sit around large oak tables and discuss how to further increase their profits so that they can pay the CEO salaries as listed above. There is simply no way to control rising premiums in this kind of environment. That is why some experts state that our current system of funding healthcare is “unsustainable.” Eventually, hardly anyone will be able to afford the premiums, and the markets will collapse.
I do think that some of these problems with the ACA, and others I haven’t mentioned could find remedies if Congress would work together for the good of the American people. But, I digress. . .
In the midst of writing this article, I encountered this editorial, echoing some of the same points. www.nytimes.com/…
drkathieforcongress.com
www.crowdpac.com/...