Who Have We Become?

Speaker Paul Ryan’s new call to repeal the Affordable Care Act is either a bluff or completely blind and heartless. Imperfect as it is—and the legislation certainly has flaws—the Act assures people have access to health insurance even with a pre-existing health condition and fewer families face bankruptcy, crushing debt or lose their homes because of medical costs.  Hospitals and doctors are now held accountable for patient safety and outcomes. They face public reports and fines if they fail to do so.  They beginning to focus on value and send one bill for a procedure, such as hip or knee replacements, rather than two separate confusing bills.

Insurance companies now must limit their profits and administrative costs to 20 to 25% of member premiums. If they fail to do so, they must return some of the premium dollars members paid. Insurers can no longer set a lifetime maximum financial limit on what they will pay for a person’s medical costs.  People can get coverage immediately when they buy insurance not wait for their coverage to begin. Medicaid now covers more people, including single males for the first time. Individual have subsidies to buy insurance. Nursing homes must report their ownership, a first step to hold them accountable.  Doctors must now report their financial ties with pharmaceutical companies. Hospitals can  now  be fined $50,000 for failing to survey community health needs and developing a plan to meet those needs.

With exceptions for some employers, all insurance policies must offer the same Essential Benefit packages.  This guarantees some promise of administrative simplicity and guaranteed benefits people can count on, thereby reducing wasteful administrative costs. People can choose the basic set or they can buy additional benefits. Mental health services must be covered like all medical and surgical procedures. There are many more provisions.

Do we really want to eliminate these new assurances and protections? What would happen to this new accountability that is finally tied to financial fines?

The cry to repeal the ACA as ‘government run’ health care ignores the fact that we already have tax based ‘government run’ health care from Medicare, Medicaid, Department of Defense, Children’s Health Program and the Veterans Administration as well as for the very group calling for its repeal—Congress itself whose benefits were some of the richest in the country until they had to purchase insurance through the federal health insurance exchange.  This includes their staff and all the other Congressional staff.  It should be no surprise Congress is keen on repealing the ACA.

Right now, nearly 60 to 70% of American health care is paid by public dollars.

Our own tax dollars are not restricted to federal programs.  We also pay for health care benefits in each and every state, county, and city across the country.  These tax based programs are not included in the ‘government run’ health care cry because they are not “federal” tax dollars.

There are 50 states with their own taxes, five territories, and Washington DC, a federal district. In addition, there are over 39,044 general purpose local governments, including counties, municipal governments and townships and over 50,000 special purpose tax districts whose health care benefits are paid by state and local tax dollars. These costs are not inconsequential.

Most of these public agencies have separate rules, covered benefits, co-pays and deductibles.  Most contract with private insurance companies. None of these groups were required to offer the same benefits before the Affordable Care Act. These separate programs were littered with legions of separate bureaucracies and untold administrative costs and wastes in nearly every city, state and county in the country and in the insurance companies they hired.   This does not include all the staff in hospital and in physician offices needed to verify coverage, networks and allowable charges.  Nor does it include the cost of fraud because the system’s complexity makes it easy to file false claims,  send incomprehensible bills or charge for procedures or services that were never provided.

That’s where our health care tax dollars have gone—to duplication, exceptions, different benefits, rules, fraud, waste, bureaucracies and separate insurance rules and unfathomable costs.  Not to mention all the separate and incompatible information systems and Electronic Health Records that often cant ‘talk’ with each other.

Do we really want to go back to all these uncontrollable costs, waste, duplication, gaps and lack of accountability with multiple tax paid administrative costs and insurance bureaucracies because nearly every group has different rules, costs, networks, co-payments, deductibles and coverage?

Let us not forget that before the ACA, 43 million people declared bankruptcy, racked up excessive debt or lost their homes to medical bills.  These 43 million people equal the combined populations of Ohio, Illinois and Pennsylvania.  This also includes 25% of all senior citizens who lose their homes because of medical bills.  You probably know some of these people.

Flawed as the ACA is we have the beginning of many protections we never had before.  We have new tools to hold the system financially accountable including insurers, hospitals and doctors and to some extent pharmaceutical and medical device companies, among others.  The ACA is far from perfect, but if we spent half the time making it work rather than spending tax dollars and time on yet another Congressional vote or yet another Supreme Court challenge, we may just have the funds to fix it.

The fact is the transition to any new system whether it is Medicare for All or Health Savings Account and privatized health care would face similar problems simply because of the sheer size and complexity of the current system.

If the ACA is repealed as Congress promises to call for again, we can just hand our health care back to insurance companies and special interests. Congress and its staff will regain their generous benefits paid by our tax dollars. We will be unable to limit insurance company profits and administrative costs, which includes executive salaries and bonuses. We may no longer be able to hold hospitals financially accountable for errors, infections and patient safety and outcomes.  And we will toss millions of people back into the ranks of the uninsured.

If we abandon the Affordable Care Act what have we become?  Certainly not the nation that was founded on being a government of the people, by the people and for the people.

Kathleen O’Connor© January 2, 2015

About Kathleen

Kathleen O’Connor: 30+ year health care consumer advocate, non-profit executive and author. For more information about Kathleen, please see “About” on the main content bar above.

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