The Patient Protection and Affordable Care Act (PPACA), known colloquially as the ACA or Obamacare, went into effect in 2013, and directly affects more than 20 million Americans.
The goal of providing all American citizens with some kind of health plan has proven to be more elusive than was expected.
There are many reasons for this situation, including eligible individuals not signing up or dropping out; large insurers’ abandonment of health exchanges; and a number of states still opting out of expanded Medicaid coverage.
One of the rallying cries of the 2016 Republican presidential campaign was to “repeal and replace” the ACA. Since the law was originally passed in 2010, Republicans have had the better part of seven years to develop an alternative plan that would address the numerous well-known issues of the ACA, such as its substantial expense ($1 trillion in the first five years); an individual mandate that, constitutional or not, carries an inadequate penalty for those choosing not to enroll; lack of a truly “free market” where plans could be purchased competitively and/or across state lines; and the glaring lack of tort reform, a major driver for the high cost of American medical care.
Some examples of mistakes being made in these current legislative efforts are as follows:
The lack of bipartisan involvement, ensuring that whatever (if any) law results could then be “replaced and repealed” should the Democrats regain control of Congress and the White House.
A “blunt instrument” approach to cost cutting, rather than placing a focus on the root causes of why medical care is so expensive in the first place and setting up workable and equitable programs to rein in these costs.
Establishing programs that could trim Medicaid rolls by job training and skill building so that more able-bodied individuals could become employed and purchase their own plans, albeit still aided by some degree of state or federal subsidies.
Exaggerating the preferential financial treatment of those making comfortable incomes at the expense of those with lesser or marginal incomes.
The biggest single error going forward is the “rush to judgment” approach of rapidly ramming something through Congress even with tissue-paper margins that, in the end, could be just as unsustainable and problematic as what we already have in the ACA.
I have never fully accepted that most of our elected officials know more, or even as much, about patient care, medical economics, the insurance industry or the nuances of integrating multi-layered healthcare systems than those directly involved in one or more of these areas.
If responsible legislators in either party still exist – and I am thinking their numbers are relatively few and rapidly dwindling – the most sensible approach to dealing with health care legislation for all Americans is to get individuals, including but not limited to representatives of both parties, with background knowledge and expertise in the individual facets of large and small healthcare systems, to sit around a common table.
It is only then that we could come up with long-term solutions which we all could support and begin to implement.
Whether you are having an appointment in your physician’s office, lying on an operating table, being seen in an emergency room or having a baby, the furthest thing from your care provider’s mind is whether you are a registered Republican, Democrat or Independent.
Let us never forget that, like church and state, medicine and politics should have well-defined and maintained degrees of separation.