When it comes to the Affordable care act Americans seems to be divided. A substantial proportion of our country remains opposed to Obama's attempt at health care reform but I, as a practicing physician, can't seem to figure out why.
In the year 2011-2012 I made it through a Masters in Public Health at a University where some of the faculty actually advised the Obama Administration, and I earned that degree yet somehow I learned next to nothing about the ACA. Recently the debate on the ACA has turned up a notch when I realized I knew precious little about the law besides what I had regurgitated from blurbs on the TV news I decided it was time to inform myself.
What I realized is that while The ACA may not be perfect and it will undoubtedly cause some problems in the short term, it is an essential step for fixing our broken, inefficient and under performing health care system.
I may not have learned a lot about the ACA in my MPH, but what I did learn a lot was how our current health care system works, the role of health and wellness in society and the importance of health and productivity to the solvency and economic potency of our nation. An unhealthy nation can not survive and we as a people are becoming increasing less healthy. It almost entirely traces back to a lack of preventive care and lifestyle related illness. I also learned a lot about where our health care system fails, a place most Americans choose not to look at until they or a loved one is sick, and how it costs us deeply both morally and in the pocket book.
If I had to summarize the current American Health Care system in one saying it would be "Spend the most, Get the Least." To me this is a slogan that most Americans are blissfully ignorant to. Any person who dares to utter that we have "the best health care system in the world" is, to put it politely, just painfully and unequivocally misinformed.
To understand the problem in the current health care system and why the ACA is essential you need to understand a few principles about health care in America.
(1) First and foremost is that America spends the most on health care of any country in the world by far, and it isn't even close. It is estimated that the United States spends about 18% of its annual Gross Domestic product on health care averaging out at over $8000 per citizen per year. This is by far tops among the 34 industrialized democracies that are members of the Organization of Economic Cooperation and Development. Second on the list is Norway who spends 12%, or approximately 33% less than the United States. Those horrible single payer systems in Canada and the United Kingdom, long derided in the States for their expense and inefficiency, spend 11.4% and 9.6% of their GDPs on health care, billions upon billions of dollars less than the US and consistently outperform the United States on most objective measures of quality.
(2) In spite of our high health care bill, we are providing inferior care to the population. It seems like a logical and basic idea that when one spends the most on something they should in return get the most back. Unfortunately when it comes to health care in the United States the complete opposite is true. In fact when public health scientists have studied how the United States performs on measures of quality versus other industrialized nations we either come in last or near last. For example, we have the highest infant mortality rate of any industrialized nation. In some parts of our country, like on Indian Reservations or in poor urban areas, the infant mortality rates are comparable to some of the poorest nations in the world in Africa. When we look at measures of managing chronic disease in terms of quality and quantity of life our sick people do worse than the sick people in other countries. For example, a diabetic in any other industrialized nation is likely to live longer and better than a diabetic in the United States.
We could say the same for any number of other chronic diseases like heart disease, lung disease, cancer and HIV. Why should America's sick people have less years and less quality years than those, say in France, Germany or Japan, when we spend more on health care than those nations. What are spending all this money for?
In fact in the year 2000 we set a series of goals for our nation called "Healthy People 2010." We met almost none of those goals, despite spending the most on health care of any country in the world in that decade.
(3) We decided long ago in this country that no sick person will go without medical treatment. THE ACA IS NOT ABOUT PROVIDING UNIVERSAL HEALTH CARE TO AMERICANS. Here is a revelation that I bet most Americans do not realize: WE ALREADY HAVE UNIVERSAL HEALTH CARE IN THE UNITED STATES. The ACA is about providing universal. or near universal, health insurance to Americans. Walk into our emergency rooms and you will see the masses if indignant people who use the emergency rooms in our country for the care of routine medical problems. No one get's turned away from out hospitals and we already take care of everyone: We just do it in the most expensive and inefficient way possible.
When you understand those 3 principles (that we spend the most, get the least and we are currently taking care of everyone in the most expensive least efficient way possible) than you understand why health care reform in this country is essential to the future of our civilization. We can not continue like this. Our sick and our healthy people deserve better.
So why do I support the ACA?
The ACA is about shifting the focus to preventive care and care in the community. It is about paying 70 dollars for a flu shot, instead of paying 70000 for 4 day hospital stay for the flu. It is about paying for 500 dollars for prenatal visit and labs for a mother. instead of millions for a case of neonatal Hepatitis. It is about paying 5000 for a colonoscopy, instead of millions for a case of colon cancer. In fact under the ACA all preventive services will be covered by insurance providers. This is essential.
In order to do this the ACA tries to ensure that as many people as possible have insurance. This directly saves costs by ensuring people have access to physicians in the community for preventive services (vaccines, cancer screening, other disease screening) and the management of chronic diseases. For example a patient with worsening COPD can see their doctor and get an inhaler to treat their problem for a total cost of a few hundred dollars, instead of waiting until their problem is out of control and they are forced to go to the emergency room of a hospital and costing the system tens of thousands of dollars.
One provision of Obama Care that is essential is the "Individual Mandate." This requires that all Americans have health insurance or face a tax penalty. The reason for this is simple: Because every one of us will get sick eventually, all of us must pay into the system. This really isn't about individual rights: It is about basic economics and fairness: You have to pay into the system to get something back from it. Simply put: Everyone can't get something for nothing.
The law also will expand Medicare to 16 million more Americans and allow children to stay on their parents insurance until age 26 again in the spirit of keeping people insured for the same reason: Uninsured people are expensive. Furthermore, the ACA requires that no insurance company can turn someone away if they are already sick, or stop covering someone because they got sick.
Another essential provision of Obama Care is the "Employer Mandate" This requires that all small businesses over 50 employees must provide their employees with insurance or face a tax penalty. In exchange for providing insurance, these companies will benefit from a significant tax credit. While this undoubtedly will affect some small businesses adversely, it is worth mentioning that only 4% of Americas small businesses are businesses that are over 50 people that don't already provide insurance to their employees.
The major goal of the ACA is to provide health insurance care to the 50 million Americans who are uninsured and the reason for this is simple. All 50 million of these individuals are going to get sick eventually. It is unavoidable. And if they haven't bought into the system then the rest of us will have to pay for them. If they don't have access to affordable care and preventive care in the community then we will pay a lot for them in expensive hospitals and emergency rooms, often times when their illness is too advanced to cure. At that point we should factor in the cost of their lost productivity into our calculations of losses and gains. What might cost mere dollars to fix ends up costing thousands or millions.
America is becoming a nation ravaged by poor health (mostly because of lifestyle related illness) and it is severely impairing our ability to remain strong and productive. I don't postulate that the ACA is a perfect law, but it is going to help. There are going to be problems with it. Some businesses will be adversely affected and some people will lose their jobs. Others may lose their insurance. But the net gains will far exceed the losses so we have to endure the problems. What I am confident of is that in the "big picture" health care reform is essential to the survival of our civilization.
In spite of the initial costs and difficulties I believe the ACA will ultimately save The United States a lot of money, but we can debate all day about the economics However, besides all the weighing of tangible pro's and cons, in a civilization that spends money all over the globe on all kinds of things, isn't protecting the health of it's citizens simply the moral thing to do? Is there a more noble expense for the richest country in the world? Is it not wrong that babies in this country are dying of preventable diseases every day because they can't get to doctors and old men who could live another ten years live don't get to see their grandchildren grow up because they can't get a doctor? This is not just an economic issue, this is a moral one.
Every generation has to face challenges and sacrifices. Our grandparents generation had to fight a viscous war overseas to save the world from a tyrant and protect our safety and liberty. Today what threatens us, and costs us lives by the thousands, isn't a foreign invader but an unhealthy lifestyle and an inefficient health care systems. The net amount of suffering and loss caused by this is massive. One of our generations tasks is to make America a healthier place and to reform this broken, inefficient system for the betterment of the future to ensure the next generation of Americans has access to health care. We are going to have to make short term sacrifices to ensure it.
I am rooting for the ACA because I believe it is a big step towards doing that and, at the very least, I hope Americans take the time to learn about the ACA and the rationale behind it from unbiased sources before they make up their minds.
