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ACA: Not ideal, but positives outweigh negatives in short term (Part 2)

Jack Bernard, a retired SVP with a large national healthcare firm, has worked extensively with hospitals across the nation regarding cost containment and insurance. He was also the first Director of Health Planning for Georgia.
Jack Bernard, a retired SVP with a large national healthcare firm, has worked extensively with hospitals across the nation regarding cost containment and insurance. He was also the first Director of Health Planning for the state of Georgia.

Obamacare (ACA) does address a number of key systemic insurance problems, for example, pre-existing conditions. Prior to the ACA, an unemployed 60-year-old generally could not get affordable insurance if he/she had a heart problem, cancer, bad diabetes, and so forth.
If that person had a heart attack, it might take their life savings to pay the bill. If they did not have enough savings, they would go bankrupt. Prior to the ACA, 60 percent of bankruptcies were attributed to medical bills, accounting for nearly 650,000 bankruptcies (CNBC, 2013).
Plus, the ACA forced standardization to upgrade policies, which is where the conservatives have hit it the hardest via the “patient driven” rhetoric.
It is not as simple as those T.V. talking points would indicate. For example, the 22-year-old working man might say that there is no need for his policy to cover obstetrics because he and his wife do not intend to have more children. When the unexpected pregnancy occurs, the family is forced to decide whether to terminate the pregnancy or go into debt to pay the bill. The ACA now mandates that policies cover all pregnancies.
What about the 40-year-old working single mother of two who states that mental health need not be covered under her policy? When her 18-year-old son has a breakdown, how will she pay for treatment? Will she have to sell her home? Or, will the son simply go untreated and be unemployable? The ACA now requires mental health coverage in all policies.
The other Obamacare coverage/cost issues, partially caused by Trump administration policies, are also solvable short-term. The geographic markets that are having problems with insurers either pulling out or raising rates can be stabilized via: A. compelling younger, well people to purchase insurance, thus spreading the risk over a healthier base and B. having government reinsurance in order to lower insurance company risk. A bi-partisan group of Senators is currently working on this matter.
The ACA is not ideal, but it promotes coverage for the uninsured and better coverage for those who previously had ineffective, incomplete policies. Even with its imperfections, the nation is a lot better off now than before the ACA’s enactment. And, it is certainly better off with Obamacare versus Trumpcare whereby premiums would have sky rocketed for seniors and coverage would be lost for tens of millions of Americans.
In the wake of the abysmal failure of Trumpcare to achieve Trump’s stated goals of lowering premium costs while increasing coverage, the best long term technical solution for our health care crisis is single payer, as stated in a prior column. Simply expanding traditional Medicare to cover everyone, while toughening fraud and abuse provisions, is just common sense. Single-payer systems are in place in over a dozen developed countries which all have universal access, lower costs, and better health outcomes than the United States (Commonwealth Fund, 2017).
Technical solutions are very different than political solutions, and I am a pragmatist. I know our political system is based on money, especially now that activist members of the Supreme Court have decided to gut well established bi-partisan campaign financing reform laws (Citizens United).
Due to the opposition of the pharmaceutical, insurance, and health provider industries who generously fund political campaigns of both parties there is very little chance that Medicare will be expanded anytime soon. Obama had a Democratic House and Senate and it did not happen in 2009.
Health care businesses are just making too much money and do not want a level playing field whereby a buyer (the government) can call the shots. A fragmented health financing system such as ours favors the sellers of goods and services.
My belief is that when the demographics of swing states like Texas, Florida, and Georgia change (and they will), things will change, permanently.
The Supreme Court will eventually have new members who will reverse these “money in politics” decisions, and that will lessen the influence of special interests opposed to single payer. But, of course, that is very long term.
Even more compelling are the cost pressures. When I was Director of Health Planning for the state of Georgia in the 1970s, health care was 8 percent of GNP, now it is more than double that and still rising. These dollars could be spent on infrastructure, education, alternate energy and many other worthwhile endeavors.
Due primarily to these cost pressures and the fact that (partially due to Obamacare) our citizens now view health care as a right, the United States will inevitably end up with Medicare for All. The only question is how long this process will take and how many Americans will die unnecessarily in the interim.