Anyone who read the Affordable Care Act (ACA) when it was
first enacted, has a basic understanding of how health care works, and
comprehends the reality of the political world we live in isn’t surprised with
how the implementation of the law has turned out so far. Unfortunately there
aren’t many who possess all three traits.
From the beginning, the law was too big, too overreaching,
tried to accommodate too many special interests and placed implementation responsibility
in the control of a government not capable of its execution. The law has tried
to create a universal health care environment with private market incentives in
a private market that has little interest in creating a universal health care system
in the first place. The pieces were just not going to fit together.
To be fair, the ACA has accomplished some good things by
getting rid of some of the insurance underwriting practices that prevented the
sick from having a means to pay for health care expenses and provides access
to
health insurance to those who have not been able to afford it in the past.
However, when you compare it to the number of people in the individual market who
have been negatively impacted by this implementation you have to wonder if there
might have been a better way to achieve better results. Unfortunately, things
are not likely to get much better in the year ahead when employers are thrown
into the mix.
The ACA is going to end up costing much more than originally
anticipated and it still doesn’t even address the primary issue facing the
country- increasing health care costs. The only way we’re going to address the
cost problem is by creating a real health care system in this country that
focuses on efficiency, collaboration, outcomes, and prevention. Reforming
health care is a supply-side problem and the ACA focuses primarily on the
demand.
There are alternatives to the ACA being discussed. These
ideas (the main ones being the Empowering Patients First Act and the American
Health Care Reform Act- you can find them by clicking here) also focus on the
demand-side of the equation and will require market changes that aren’t going
to be any easier to implement than the ACA. But they still don’t address the cost
and inefficiency issue we are facing.
Numerous studies have indicated that anywhere from twenty-percent
to over half of what we spend on health care is wasted in the delivery system
we have today. We see it every day (the wasted money on web sites for the ACA
is just another example.) By improving the way doctors, hospitals, and patients
work together, changing payment and incentives, improving technology and
communication, and eliminating the ungodly waste that exists we could easily
pay for access to health insurance for those who need it while addressing the
fundamental cost issue we face today.
While our politics and general public continue to focus on
the availability of health insurance (demand) we’re continuing to focus on the
wrong side of the equation. We need supply-side reform to make it work.
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