The majority of those polled would like to see the Affordable Care Act (ACA) modified. My suspicion is that the majority of these people do not a constructive solution to offer. Or else the healthcare system is so complicated that they hope that ‘someone’ will be able to fix it. If we think that ‘someone’ in politics is going to fix the problem, it might wise to see if they have had any experience in fixing any health care systems. The majority of politicians make it their career. Their ability to handle their personal finances and activities prior to being elected is often less than impressive. So it may be naïve to think that ‘someone’ in politics is going to be able to fix the ACA.a
For those who have access to health care, it is a much easier conversation to simply be against the Affordable Care Act. For those without insurance they want to keep the Affordable Care Act (ACA) in place. Political parties will always slant and interpret the data to support their talking points. I wish their motivations were focused on identifying those are really in need removing the barriers that prevent them from getting the health care they need. But at the same time, both parties need to realize the negative impact that the ACA has had on the middle class. A healthy middle class is crucial for any society to sustain itself.
The real costs of health care (office visits, surgery at reasonable prices, prescriptions, etc.) have been very close to the Consumer Price Index (CPI) for decades. HealthInflation was a publication that used to track every sector of health care costs, and they concluded that health care costs increased about 3-5%/year. (This publication is no longer in print) Insurance premiums and the administrative burdens have dramatically increased for decades, and disproportionate to the reals costs of health care. The reason this happened was the progressive insulation of the real costs from the perceived costs. Hospitals are magicians at inflating the costs of their services. Then they write this off as charity care while expecting the Federal government to reimburse them for ‘unfunded care.’ This has caused many people to face bankruptcy. A recent report has concluded that 62% of bankruptcies were related to medical bills, and yet 75% of these people had insurance. Massachusetts has one of the highest percentages of citizens having insurance, and yet the ACA has done very little to decrease the number of bankruptcies.
I am not biased to one political party. My comments are non-partisan. Admittedly, I am not a supporter of the ACA, because there are so many blatant flaws. I read an interesting commentary in Modern Health Care that suggests the ACA has helped improve transparency. Really? Where? I must be on the wrong planet. The ACA has muddled the costs for insurance, office visits, prescriptions, and surgery.
My comments are from someone who is on the front line of health care delivery. In addition, in the past I had the opportunity to meet with many Medicaid leaders throughout the country. I was impressed by their dedication to serve, but disappointed by their lack of understanding of their budgets and realistic goals. My efforts are focused on keeping people off the expanding Medicaid roles. It has been said that a crisis will force those with constructive creative thoughts to find the opportunities for resolving the crisis. Historically, Medicaid has been a disaster at the State level. It is difficult to determine how many people are on the roles and how to balance their budgets. As a result, they look to the Federal Government to bail them out. The Federal Government expects the shrinking taxpayer base to pick up the tab.
Because taxpayers are becoming an endangered species, printing more money is the Federal Government’s solution to fiscal challenges.
Practical suggestions for the States to consider with the block grants that they will probably receive:
1. Scrutinize the disability determinations carefully. Many see disability as their only option for survival.
2. Educate those who need health care to pursue the most cost-effective portals. Physicians should lead the way in helping their patients get through the confusing maze of health care. I have given ways to access affordable lab tests, MRI, and surgical sites (www.libertyhealthgroup.com).
3. Focus on helping the middle class by dismantling the mandates in the ACA that escalate premiums.
4. Encourage businesses to set up a Health Reimbursement Arrangement (HRA) for their part time employees to help pay for their non-emergent health care needs.
5. Consider setting up HRA for the Medicaid population within your state. This money that is credited to an account, in the event of a medical need.
6. Access affordable health care portals, such as Same Day Surgical centers, physicians, and diagnostic centers that post their prices.
7. Stop allowing people to purchase cigarettes and alcohol with food stamp money.
8. Money for health care needs can be placed onto a debit card with restricted purchasing options. Only qualified medical expenses will be approved.
The Health Exchanges have been a miserable failure. So why do we keep trying to prop them up? Jane Orient, MD recently compared the ACA to the leaning tower of Pisa. This tower will eventually fall, because of a faulty foundation. Similarly, the ACA will eventually fall because it was built on a faulty foundation. The sincere supporters of the ACA must admit that they were sincerely wrong. The ACA has done nothing to control costs. Any improvement in access to health care has been offset by increasing the waiting lists to see physicians and cost prohibitive premiums.
You can put lipstick on the ACA toad and kiss it all you want to but the Prince will never appear.
While the pundits keep kissing the ACA toad, I will continue to Educate & Empower my patients and business owners regarding access to affordable care. I implore politicians to aggressively reconsider the non-profit status for hospitals. A line from a children’s song seems appropriate, “If we all pull together, how happy we will be.”