President Trump just removed federal funding for Affordable Care Act (aka ACA, Obamacare) subsidies. Here are five quick answers to questions you should have about this action – and a resource. 1.Exactly what happened – I thought Congress approved the ACA. How can he do this? The funding in question isn’t the global pot of money that sustains the Affordable Care Act, but supplemental funding under the control of the Executive Branch mean to subsidize (i.e. reimburse) insurance companies for maintaining relatively low rates for lower-income ACA enrollees. 2. Does this mean the ACA is no longer funded? Actually no. Nothing changes immediately, but you should expect the insurance companies to react to the loss of these subsidies and pretty dramatically raise rates.
3. What will do to my insurance under the ACA? Over time, expect your rates to skyrocket by an amount proportionate to the revenue lost by the insurance companies. Alternatively and/or additionally, with this and the other assaults on the ACA by President Trump, you can anticipate many insurers leaving the ACA exchanges due to the uncertainty these actions bring to the system. Of course, if this happens, you’ ll disproportionately affected if you’re in the group for whom the subsidies was intended (i.e. lower and middle class) and/or live in the South.
The newest effort to repeal and replace the Affordable Care Act (aka Obamacare, ACA) is called the Graham-Cassidy Bill. Although the actual legislation has been clouded in secrecy, there are a few fundamentals that can be shared, and we’ll present them in Q&A format. Be reminded that this reform is meant to impact approximately 1/6th of the United States economy. We’ve done our best to prevent facts Straight, No Chaser style, so consider points that seem slanted self-evident truths and evaluate your reaction to them.
I. What’s a block grant? Let’s address both the facts and the spin. Block grants are a means for the federal government to cap expenses by taking a fixed amount of funds (typically what’s currently or historically being spent) and offering those same funds to individual states for their management. This isn’t a new idea. Republicans have been pushing block grants for Medicaid since the Reagan administration (1981). Block grants were notably used in converting welfare (Aid to Families with Dependent Children) away from an entitlement program in 1996. The spin (and the danger) is states would be allowed to manage those funds as they saw fit, which allows for either greater or lesser health protections, as well as innovation and restrictions. Simply put, states would be empowered to decide what services are offered and who would qualify for those services.
2. What would happen to Medicaid? In the block grant scenario, the amount would be capped with annual adjustments to account for inflation, but those amounts would not keep pace with the rate of medical inflation. In other words, states would eventually have less money with which to work. Furthermore, the proposal explicitly ends coverage for childless adults and ends the Medicaid expansion that occurred under Obamacare and currently covers 15 million adults. As such, there will be a massive redistribution away from states who opted into the ACA Medicaid expansion toward those that did not. Although the Congressional Budget Office hasn’t yet had time to score the Graham-Cassidy bill, in the past, it has opined that block grant proposals could cut Medicaid spending by as much as a third over the next decade. That’s not all. Most notoriously, the block grant would end after 2026. That’s right, in ten years the federal government would have to renew the grant, or states would need to replace every last federal dollar or roll back coverage even more. In other words, all funds currently assigned to Medicaid and the ACA would no longer be spent by the federal government in ten years under the currently proposed bill. Whether or not you believe in reducing costs, you should be quite concerned about the lack of market stability that represents, much less what’s going to happen to health care in 10 years. A conservative estimate is tens of millions of Americans will lose healthcare under any scenario of Graham-Cassidy.
3. How are preexisting conditions affected? Here’s the facts and the spin. Based on the best information available, states would be required to “offer” services to those with preexisting conditions. However, remember that services are actually provided by insurance companies. This bill neither addresses pricing nor mandates affordability to those covered. Thus, a health service could be offered, but it is probable that the price of coverage will become so high for the high-risk patient and those with preexisting conditions that they’ll either elect to or not be able to pay the cost. The nuances here allow competing interests to claim both that pre-existing conditions are or are not going to be covered.
4. Is this supported by the medical and public health communities?How about the public? Every conceivable apolitical sector, from hospitals, insurance companies, health organizations and the public are speaking out against this proposal. On Saturday, a joint press release was signed by multiple prominent medical organizations and insurance companies, united in opposition to the bill. Signing healthcare entities included the following: American Medical Association, American Academy of Family Physicians, Federation of American Hospitals, American Hospital Association, American Health Insurance Plans and the Blue Cross Blue Shield Association. Here is a quote from the press release: “While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable healthcare market that provides access to high-quality care and affordable coverage for all… The Graham-Cassidy-Heller-Johnson bill does not move us closer to that goal. The Senate should reject it.” Only 24 percent of Americans support Graham-Cassidy, according to a new poll released Thursday by Public Policy Polling. Meanwhile, the public supports retaining the Affordable Care Act over replacing it with the proposed Graham-Cassidy bill by 56-33 percent in a new ABC News/Washington Post poll.
5. What’s going on with Obamacare (Affordable Care Act/ACA) these days? It actually is very much intact, although multiple executive orders have been enacted to weaken it (that will further the appearance and reality that it is flawed). The Trump administration has reduced advertising funds by 90% to announce enrollment, but you should know enrollment for 2018 starts November 1 and ends December 15.
6. Are there any women’s health concerns? It is implicit in the effort to rollback delivery of healthcare to the states that politics will play a role in multiple issues, including those of women’s health. It is explicitly of note that the Graham-Cassidy proposal eliminates federal funding to Planned Parenthood for one year.
7. How can I express my concern? What follows is an exhaustive list of contact numbers for your Senators. Media reporting suggests the number of calls hasn’t been close to that of previous efforts to repeal the ACA, so if you have a voice to share, you have until week’s end (Friday) to be heard.
The government may have “moved on” from healthcare, but we the people haven’t. This Straight, No Chaser addresses some very simple fixes for the Affordable Care Act (ACA). For starters, let’s operate under a few assumptions that may or may not be true, based on the recent efforts with the American Health Care Act (AHCA):
The government has come to understand that the American public believes healthcare (or at least access to it) is a right.
The government has come to understand that it must have a role in protecting the interests of the American public regarding how healthcare is delivered.
I also offer a third assumption that the American public would do well to understand about our nation’s healthcare product:
Healthcare in the United States is an industry, not a system. With between $2-3 trillion in commerce being exchanged, the government is not going to bankrupt the insurance, hospital and pharmaceutical industries by putting in place a socialized medicine model (which frankly is not necessary to guarantee universal healthcare). Practically speaking, when speaking of a “uniquely American” solution, a heavy dose of capitalism will come into play for any reform efforts made.
Here are three principles and nine specific suggestions that members on both sides of the aisle (unless acting in a purely ideological manner, meaning either only socialized medicine – government-owned, operated or controlled hospitals, pharmaceutical, and healthcare providers – or no governmental involvement in the business of insurance companies providing health coverage and letting the free markets figure things out) could agree would improve the Affordable Care Act, or more importantly would improve healthcare under any system.
Expand the number of participants. The reason to do so is simple: the more individuals that are compelled to participate, the more risk sharing exists, allowing for overall cost reductions because of risk pooling. Options for doing this include the following.
Continue the expansion of Medicaid. Kansas and North Carolina are already primed to become the 32nd and 33rd states to expand Medicaid under the ACA. Before President Trump was elected, Georgia, Idaho, Nebraska and South Dakota were considering Medicaid expansion, and now that the AHCA has been pulled, they will likely revisit consideration.
Eliminate the individual mandate and replace it with a provision by which the government collects a tax in the same way social security and certain other taxes are collected, thus making the individual mandate “invisible.” Furthermore, means test the cost of insurance based on income and your choice of services, instead of by age. Individuals are going to need and use healthcare in the same way that police and public schools are used (Note this is not the same as forcing individuals into using public healthcare and removing choice). If people are going to use it, why not compel everyone to buy into the system? And while you’re at it, once you’ve means tested the cost of insurance based on income, then real consideration can be given to removing the employer mandate.
Increase competition. Yes, there is unnecessary waste in the system. Let’s work to bring costs down by embracing the capitalist construct of competition. Here’s a few simple ways how.
Allow for competition by insurance companies across state lines. Competition everywhere will promote lower prices.
Allow for purchase of pharmaceutical products from Canada and wherever quality can be assured.
Provide a “public option.” If it is a bridge too far for the government to influence the costs of healthcare by setting prices directly to insurance companies, pharmaceutical companies and hospitals, providing an actual government-run insurance product option in which such price-setting did occur would compete with and compel these entities to fall in line.
Drive utilization toward less expensive, more efficient products
Provide transparency in pricing. Have you ever noticed how rare it is for you to have any idea what the cost of services is? How can that make sense? For many forms of care, there are a range of services within the standard of care. Allowing patients to act as informed consumers can serve the purpose of lowering costs without reducing quality.
Allow for bundling of services: Along the same lines as promoting transparency, moving away from separate fees for every individual service, medicine and gauze used and toward charging standard fees for different categories of services can create huge opportunities for savings and efficiencies.
Maintain the “essential services” the “80/20 Rule”. Simply put, an ounce of prevention is worth a pound of cure. The more preventive and basic (essential) services are utilized, the better health outcomes become and the lower costs end up. The 80/20 rule (aka medical loss ratio) requires insurance companies to use 80 cents of every one of your dollars spent on your medical claims and specific activities meant to improve the quality of healthcare (if and when they don’t, you get a rebate).
Rethink utilization of the emergency department and ambulance services. Millions of ambulance runs each year only represent the equivalent of taxi rides. Utilization of emergency departments occurs without any determination that other components of the healthcare system couldn’t be used, and for approximately thirty years, ERs have operated under an unfunded mandate to provide expensive varieties of the same care that could be rendered in a primary care office. This is a huge problem in that it has continually been shown that approximately 80% of ER visits could be effectively addressed by other healthcare options, and it’s also an issue because ER visits are approximately seven times the cost of using a family practitioner for the same presentation. This represents billions of dollars annually, and it’s also a major contributor to hospital costs representing the primary cause of personal bankruptcies. Just because you’re not paying upfront doesn’t mean you won’t be held responsible later. It’s time to implement some form of selective approval of ambulances and emergency room usage.
This blog strives to provide medical and public health information – not to serve a political agenda or display any other forms of bias. It is not a means of generating income or serving sponsors. It is with that in mind that I ask our tens of thousands of readers and supporters to consider the following five truisms you should think about deeper that the ongoing slogans would have you do. With a Congressional vote coming today, forget what you’ve heard about the American Health Care Act (AHCA) being Obamacare-light (aka Affordable Care Act, ACA). There are monumental differences between the two. This is literally your life (and how you’ll protect it) that is being placed at risk.
The price of healthcare is going to continue to go up no matter what. Healthcare is an industry run by corporations, not the government. As such, corporations have a responsibility to their shareholders to generate as much profit as possible. This fact will remain the same under any plan that does not include a government-run consideration such as “Medicaid for all.”
The rate of rise of healthcare costs went down under the Affordable Care Act. One of the major goals and accomplishments of the ACA (aka Obamacare) is although costs continued to rise, it did so at the lowest rates in generations – this was by design. Consider this: according to FactCheck.org, during President Bush’s last six years in office, the average family insurance premiums increased 58% ($4,677). During President Obama, premiums went up by 33% ($4,154). Yes, costs went up (a lot), but the rate of rise slowed – and for what it’s worth, it’s amazing that no one ever seems to get much upset at insurance companies and other for-profit entities that actually are behind the increases in cost. The ACA never was insurance. It was an insurance marketplace where insurance companies agreed to provide insurance and compete for your business. You might as well be mad at the government for the cost of fast food. It’s a distraction.
A common refrain is “the costs of healthcare will go down!” Well, that’s government cost due to so many people losing their insurance. The cost of healthcare to you individually would skyrocket under the proposed AHCA (American Health Care Act). There are several reasons why. First of all, 24 million of you won’t have insurance, so you’ll be paying cash. Guess what? Cash rates are way higher than the rates charged to insurance companies. Also, those of you who don’t have insurance will be using the emergency rooms a lot. Well, the cost of ER visits is approximately seven times that of a family practice visit for the same presentations, and guess what? The cost of emergency services is one of the many items no longer to be covered under the AHCA. Also, those of you with insurance costs can expect it to skyrocket for two reasons: one, the law specifically eliminates customer protections (those nasty regulations) that fix insurance companies costs. Even if you believe in the free market’s ability to control costs, this is not that model. This will be a (not close to) free-for-all. Here’s one example: the ACA imposed a 3:1 limit on age rating, which restricted insurers from charging the elderly more than what younger citizens paid within the same area. Under the AHCA proposal; the limit will increase to 5:1. This is a huge reason why the AARP and other senior advocacy groups have come out against the AHCA. An AARP commissioned study concluded that for those over age 55 with a $25K annual income, the premium increase would be approximately $3,600/person, and a 64-year-old with the same income would see an increase of $7,000/person. If you’re 64 with an income of just $15K, your premium would cost $8,400 – more than half of your income. This is logic, math and greed. Remember the individual mandate that many seem to hate creates cost averaging. The more young, healthy people compelled to be in the ACA exchanges created a bigger pool to offset the increased costs of the elderly. With no mandate, there’s less money and no risk sharing.
The current conversation about healthcare is a nearly trillion-dollar tax cut in disguise (by eliminating the employer mandate), but what you really should be concerned about is the notion that the underlying “new normal” in play is Healthcare Is Not a Right. Folks, 24 million Americans are estimated to lose their insurance. That means many of you will immediately be placed in a situation in which you will have to decide whether to spend your disposable income on food or healthcare (including medicine). It means in many instances, whatever is wrong with you won’t be discovered until you’re in an emergency room and it’s too late, and/or the opportunity for a full recovery won’t be nearly what it would have been with primary care or preventive efforts. As if that’s not enough, the facade of insurance will become the norm. Your “new” AHCA insurance will not cover ER visits, hospitalizations, laboratory services, prescription drugs, maternity and newborn care, pediatric services (oral and vision care), preventive and wellness services, chronic disease management, mental health and substance use disorder services, rehabilitative services and devices. Get ready for personal bankruptcies to go through the roof.
There appears to be no airspace being given to the other fundamental healthcare option. As mentioned in the beginning, the narrative presuming that healthcare is not a right. The US stands alone among the civilized world in not providing universal health care. Once upon a time, the current President actually insisted that everyone needed to be covered. Where is the conversation regarding providing insurance or coverage for all in the same way police protection, education (for now) and a safety net for (some of) the most vulnerable? The goal of distraction is invariably to move away from the more important consideration.
Elections have consequences. At this point, we can move beyond mere speculation and look at the certainty that the Affordable Care Act (aka Obamacare, ACA) will be repealed at some point promptly upon inauguration of the new U.S. President. That decision will have profound effects on the healthcare of tens of millions of Americans. This Straight, No Chaser will briefly review the impact of a repeal of the ACA. As recently as June, 2016 Republicans have put forth the components of legislation meant to replace the Affordable Care Act. This information is notable both in what it seeks to accomplish and what it seeks to remove. Here are a few of the items from Obamacare this legislation specifically would have reversed:
It would have repealed the mandate for individuals to buy health insurance and for employers with more than 50 workers to provide it to employees.
It would have eliminated all fines for people and companies that failed to comply with the mandates.
It would have eliminated current federal subsidies to about 6 million low- and moderate-income Americans who buy their own insurance.
It would have rolled back ObamaCare’s expansion of Medicaid for the poor (adopted by more than 30 states)
There are other concerns not explicitly stated to be at risk but are expected to go away with the repeal of the Affordable Care Act.
Obamacare eliminated insurance companies’ ability to exclude those with pre-existing conditions.
Obamacare mandated an ability to keep children on their parents’ insurance until age 26.
Here are the components in the proposal that are to “be expanded upon” in actual legislation, with my commentary.
A refundable tax credit for Americans who don’t have employer-provided insurance. Of course, a tax credit is only applicable if you have sufficient taxes from which a deductible can occur. For the millions of Americans at or below the poverty level, the costs of healthcare spent will greatly outpace any deductibility considerations, resulting in much higher costs to this group.
Expanding the use of private health savings accounts (HSAs). HSA’s are a good additional consideration for consumers, as opposed to funneling your money to insurance companies who still will work to charge you additional fees via deductibles and co-pays. The issue, of course, is many Americans can not afford depositing money into a HSA, leaving them uninsured and exposed to higher costs.
Allow insurance companies to charge young people less and older people more. This consideration aligns usage with costs (and thus seems fair), but it eliminates the leveling of costs that keeps insurance affordable for those individuals most likely to use the system (i.e. the elderly). The most significant anticipated net effect of this will likely be higher profits for insurance companies.
Funnel the costliest patients to subsidized “high-risk pools.” As noted above, high risk pools equal higher costs.
Restructuring Medicaid and Medicare. This represents a clear opportunity but also a defined risk. Efforts to streamline these legacy entitlement programs are indeed needed and would be welcomed if they result in a higher percentage of money being used for healthcare instead of administrative costs. The time to be concerned about “restructuring” is when healthcare coverage and services for those most at risk (the poor and elderly) become cut. Watch closely for this consideration.
Despite real needs to build upon and improve the Affordable Care Act, it has had some clear successes, including the following:
Federal subsidies are now in place to about 6 million low- and moderate-income Americans who buy their own insurance.
Medicaid coverage for poor Americans has been adopted by more than 30 states.
6 million people in the United States have gained medical insurance coverage as a result of Obamacare.
Approximately 17.6 million Americans have gained medical insurance coverage as a result of Obamacare.
Simply put, in the absence of an equivalent or superior healthcare initiative, it is estimated that 24.5 million individuals will lose coverage by 2025 as a result of repealing the Affordable Care Act.
Let’s go off the grid and take a look at the intersection of Presidential politics, health care and public health. Of the three remaining Presidential candidates, each has a distinct point of view regarding the future of the Affordable Care Act (ACA, aka Obamacare).
Hillary Clinton generally says she would keep the ACA in place.
Bernie Sanders calls for replacing the ACA with a single-payer, federally administered system: “Medicare for All.”
Donald Trump has said he would repeal the ACA.
Approximately two weeks ago, Gallup polled Americans on these thoughts without identifying the Presidential candidate associated with the viewpoint. Consistent with past findings, the majority of US citizens support the idea of a fully federally funded healthcare system. Here’s the breakdown of those individual views.
58% favor replacing the ACA with federally funded healthcare system;
About half would also be ok with keeping the ACA as is; and
Just over half would favor repealing the ACA. However, only 22% of Americans say they want the ACA repealed outright; those favoring repeal largely favor replacing it with a federally funded system such as the even more liberal “Medical for All” option.
The US Supreme Court has reaffirmed the legality of the government’s ability to provide subsidies to the governmental healthcare exchanges established to deliver care in states not establishing their own exchanges. That makes this a pretty good time to review how the Patient Protection and Affordable Care Act (ACA) fits into the American healthcare landscape.
Let’s start with the data: as of March 2015, the US Department of Health and Human Services reported a total of 16.4 million people covered due to the ACA between the Marketplace, Medicaid expansion, young adults staying on their parents plan, and other coverage provisions. According to Gallup that translates to an uninsured rate of 11.9%, down from a high of 18% in 2013.
Now let’s compare this to the goals. In general, the ACA attempts a nifty set of tricks: it aims to add over 30 million previously uncovered Americans to insurance rolls while slowing the rate of growth of health care costs, then ultimately reduce the costs of care. This simultaneously makes insurance providers huge winners and slight losers (30 million new customers but less profit per customer), as well as hospitals, physicians and pharmaceutical companies, who are meant to make a little more money while working a lot harder for it. The basic premise is there’s already plenty of money in the system (America spends over 17% of the gross domestic product – over $2 trillion annually on health care; no other country spends more than about 11% of GDP on health care) to provide what we need. The ACA was truly a Republican initiative at birth, for those keeping score. It was born out of the Heritage Foundation (a conservative think-tank) and is more or less a combination of plans proposed by Bob Dole and executed by Mitt Romney in Massachusetts. It does not provide universal coverage or even “Medicare for all” (those would have been current Democratic ideas, although Richard Nixon proposed the same) or allow a governmental takeover of hospitals, insurance companies or physician practices (those would be socialized medicine). At it’s simplest, it’s a capitalist give to insurance companies of 30 million new patients with enhanced governmental oversight. Here’s those 7 positive facts: 1) The 80/20 rule: The law requires insurers to spend at least 80% of premiums on direct medical care. This nearly doubles historical trends. This is meant to expand care greatly in certain areas such as prevention and mental health. If and when this doesn’t happen, you’ll get a rebate check. 2) Preventative care is being emphasized: you likely won’t have to pay a co-payment, co-insurance or deductible to receive services such as screenings, vaccinations and counseling. 3) Preexisting conditions: Health plans can’t limit or deny benefits or coverage to anyone under age 19 because of the existence of pre-existing conditions. These protections will be extended to all ages beginning in 2014. 4) Choice and ER access: You choose your own doctor. You don’t need a referral from your primary care doctor to see an Ob-Gyn doctor. You don’t need pre-approval to seek ER services outside of your plan’s network (e.g. when you’re out of town). This means those ridiculous out of network charges should go away. 5) Young Adult Coverage: If your plan covers children, you can add or keep your kids on your policy until they turn 26, even if they’re married, don’t live with you or are otherwise eligible to have their own plan. 6) Consumer Assistance Program: This strengthens your ability to appeal and fight decisions made by your insurance provider and guarantees your right to appeal denials of payment. 7) End on Annual and Lifetime Limits on Coverage for all new health insurance plans by 2014.
The bottom line is up to 30 million American are being formally brought under the umbrella of the health care instead of relying on emergency departments or going without care. Despite not being a perfect solution, if we were to list societal priorities, closing this gap to this extent is high enough on the list that the downstream consequences are less important as considerations. As a public health initiative, this act will accomplish many things, including putting in motion changes in health care disparities due to the lack of access to care. I would challenge all the ongoing critics of the ACA to answer one question whenever they have an argument about why they continue to oppose implementation of the ACA: “Is your concern worth leaving 30 million Americans without structured healthcare?” Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd. Preorder your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com.
Did you know patients have a Bill of Rights? Actually, there’s more than one type of patient bill of rights, but in this Straight, No Chaser, we address patient rights and protections introduced as a result of implementation of the Affordable Care Act (aka ACA, Obamacare). These rights largely speak to the relationship you have with your insurance provider and apply to all plans since September 2010. In order to avoid following these rules, insurance providers would have to petition the U.S Department of Health and Human Service. Here are some of the protections that apply to health plans under the new laws:
Annual and lifetime dollar limits to coverage of essential benefits have been removed. (Essential benefits include doctor and specialist visits, home and hospice services, emergency services, hospitalization, preventive and wellness services, chronic disease management, laboratory services, prescription drugs, maternity and newborn care, pediatric services, mental health and substance use disorder services, and rehabilitative services and devices. Non-essential benefits include things like adult dental care.)
People will be able to get health insurance in spite of pre-existing medical conditions (medical problems one had before getting insurance).
You have the right to an easy-to-understand summary of benefits and coverage.
Young adults are able to stay on a parent’s policy until age 26 if certain requirements are met.
You’re entitled to certain components of health prevention and screening without paying extra fees or co-pays.
If your plan denies payment for a medical treatment or service, you must be told why it was refused and how to appeal (fight) that decision.
You have the right to appeal the payment decisions of private health plans. (This is called an “internal appeal.”) You also have the right to a review by an independent organization (“outside review”) if the company still doesn’t want to pay.
Larger insurance companies must spend 80 to 85% of their premiums on healthcare and improvement of care rather than on salaries, overhead, and marketing.
If you made an honest mistake on your insurance application, health insurance companies will no longer be able to eliminate your health coverage after you get sick. (They can still cancel coverage if you don’t pay premiums on time, if you lied on your application form or if they stop offering plans in your region.)
If a company does cancel your coverage, they must give you at least 30 days’ notice.
Premium increases of more than 10% must be explained and clearly justified.
Knowing your rights is an important way to ensure you are receiving the best care possible. Take the time to learn these rights, and use them to your advantage. Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com(SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Today’s Straight, No Chaser is another in which we comparatively analyze the performance of the U.S. healthcare system. It’s important that this be done. It’s not enough to assert we have “the best healthcare in the world” without using objective data to substantiate these claims. Unfortunately, by any objective measure of the totality of our system, we pretty clearly don’t have the “best” system in the world. What we have is the most expensive healthcare in the world, and for those at the very top levels (of wealth) in society, we have access to options that aren’t found many other places in the world, and it can be argued that these individuals have access to the best medical services in the world. But what about the rest of us, especially the 30 million Americans projected to be without healthcare, even after full implementation of the Affordable Care Act? What about the actual system?
For the fifth time in a row, including studies in 2014, 2010, 2007, 2006, and 2004, the United States has been ranked last in a review of eleven rich, industrialized nations’ health care systems by the Commonwealth Fund, a prominent healthcare think tank. The eleven countries compared include Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the US. The report clearly demonstrate that the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of health care access, efficiency, and equity. It should come as no surprise that our failure to perform is squarely tied to the lack of access that results from not having universal healthcare. The US is the only country in the survey not having universal healthcare. Consider these resultant illustration:
37% of Americans said they didn’t fill a prescription, visit a physician or seek recommended care because of the additional out-of-pocket cost considerations inherent in our system. Now compare this to 4% of citizens of the UK saying the same, and it becomes easy to understand how access to care produces better health care outcomes between countries., not technological advantages we may have. That 37% number was the largest among countries in the survey.
In case you’re interested in the study’s methodology, the report incorporates the following considerations:
Patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care
Information from the most recent three Commonwealth Fund international surveys of patients and primary care physicians about medical practices and views of their countries’ health systems (2011–2013).
Information on health care outcomes featured in The Commonwealth Fund’s most recent (2011) national health system scorecard,
Information from the World Health Organization (WHO)
Information from the Organization for Economic Cooperation and Development (OECD)
I guess the obvious thought in your minds might be about the effects of Obamacare (the Affordable Care Act, ACA).
The data that contributes to Commonwealth Fund’s survey was collected before Obamacare took effect. The authors point out that the “historic legislation” represents an “important first step” to fixing some of the US’ persistent issues with high costs and lack of access to insurance. The health reform law hopes to expand insurance coverage to millions of Americans who have been locked out of the health care system, and that could finally improve the U.S.’s rankings in areas like access and equity.
But there are still some gaps, due to resistance to Obamacare’s optional Medicaid expansion, which would extend public insurance to additional struggling Americans, about six million of the country’s poorest residents are still left with no access to affordable health care whatsoever.
More from the report: “The claim that the United States has ‘the best health care system in the world’ is clearly not true…To reduce cost and improve outcomes, the U.S. must adopt and adapt lessons from effective health care systems both at home and around the world.”
The lesson I would have you learn is to remember, the U.S. healthcare system is a capitalistic enterprise that delivers $2 trillion a year to various corporate interests. That is a statement of fact, not politics. The delivery of healthcare within this system is expected to be a byproduct of capitalism’s competitively-induced incentives to those in the business, with the expectation that the system will become the best it possibly can be as a result of pursuing that $2T. This is a completely different paradigm than building an outcomes-based system based on putting in place initiatives to accomplish the desired end results and competitively bidding down the costs to the system. We in the U.S. do not have that framework as our underlying focus. The presumption that “the market will fix” the ills of our system leaves us where we are relative to other industrialized countries. Even the ACA only seeks to build on and improve upon the existing system, not replace it with a system resembling those producing better outcomes at lower cost around the world.
Until and unless the conversation and legislative efforts migrate toward universal health care (which is still possible incorporating a “distinctly American solution/system” – despite talking points to the contrary, providing universal health is not necessarily the same as “socialized medicine”), there is no realistic reason to assume these surveys will reveal anything much different that the current results. The confusion that exists in your mind is a belief that better healthcare outcomes are actually the focus of the system. It’s not. As is the case with many other things in our country, the answer is to be found by following the money. To access the full report, go to http://www.commonwealthfund.org. Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com(SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Over 6 million of the previously 50 million American medically uninsured have already signed up for the Affordable Care Act (ACA aka Obamacare). Have you? Let’s consider this an open forum. Today is the deadline for signing up without penalty. It’s important that you realize what that means. I’m willing to answer any questions you have on signing up, penalties for not signing up and what it means to be enrolled. In the meantime, refer to these past Straight, No Chaser blogs and refer to the governmental site at www.healthcare.gov.
I welcome any questions or comments. To get you started, here’s five quick points you should know.
In order to sign up, go to www.healthcare/gov or call 1-800-318-2596.
You can also buy policies directly from insurers. However, you won’t be eligible for premium tax credits that can reduce your costs. Those who purchase on the exchange and have an income between 100% and 400% of the poverty level may get tax credits to reduce their costs.
If you fail to sign up, the fine is $95 or 1% of your income after $10,150 — whichever is higher — for a single person this year. However, that penalty increases over time and with the size of your family.
To be eligible for health coverage through the ACA Marketplaces, you must live in the U.S. and be a U.S. citizen or national. You also can’t be in prison.
The cost of insurance vary dramatically, based on your income and family size. Check www.healthcare.gov for details.