Are you better off?

Changes are coming: For Good or Worse?

There are heady times for health care. Changes circumventing the Affordable Care Act are leaving people excited and confused at the same time. The overall goal of the Affordable Care Act is to expand access of care to people previously uninsured, under insured, and misrepresented. A paradox exists in this country where uninsured people receive too little care and insured people receive too much of it. Both ends of the spectrum have profound effects on patient outcomes and the financial stability of the system. On one end, uninsured people use the system the majority of the time when it’s too late. For example, a woman may have felt a lump in her breast 9 years ago and the lack of preventative services not afforded by having insurance caused an automastectomy to occur. At this point of time, what was once known as a benign tumor and could have been treated in a matter of hours has turned into a full blown malignant tumor that has most likely dispersed to the rest of the body, including areas of the brain, lungs, liver, kidneys and heart. At this point, the patient’s prognosis is much, much worse, and tax payers and beneficiaries will incur increased premiums as a result of her doctor’s trying to extend what little quality life she has left to live. Likewise, a patient with private insurance may demand more services be provided than deemed medically necessary. Consider a patient suffering migraines. She suffers intense bouts of pain and demands that all measures be taken to correct the problem. These measures include expensive laboratory tests such as a hormonal work-up, an MRI of the head, and sensitivity tests. What may have been diagnosed as stress induced migraines has blown out of proportion in terms of costs, patient safety, and necessity.

Are the changes coming for better or worse? One argument consists from an economic standpoint. Are all people entitled to health care? The answer to this question is an obvious yes. The not so obvious part of this answer is to what extent? As I argued in one of my first posts, the government has an inherent responsibility to protect its people. This is evidenced by proper public health measures that were instituted shortly after the scare of the bubonic plague. Every country in the free world except the U.S. has superseded government responsibly in health care by offering universal health coverage. In no other country but the U.S. has the plight towards universal health been charged with such adversarial clashing. Multiple attempts have been made to set up a one payer system, but governmental attempts have met strong opposition through strong political interest groups, such as the Labor Unions, AMA, and insurance agencies. The running joke for universal health care proponents is that we are one car accident or hooker manslaughter away from enactment. Even now, with the institution of the Affordable Care Act and its policies starting to have its most profound effect on our health system, the question often arises, are we doing more good or harm?

It is of my strong opinion that the Affordable Care Act is not the answer to our unsolved problem. The Act is definitely a step in the right direction, but for real progress to be made in this country, this country is going to have to endure a complete restructuring of the entire system. The ACA addresses issues of quality and access to care, but leads no sure promise of it actually seeing fruition. HMOs were government supported, and many areas of concern caused them to compromise the system by limiting care too much, and causing doctors to underdiagnose. What started out as a great turn of events eventually lead to the ship sinking again. How can things be done different so that our future is not so grim? The whole system needs to be remodeled. It’s apparent that the more we spend on health care does not have a profound on patient outcomes. In fact, spending more creates more issues related to fraud, embezzlement, providing sub-par services, and even scarier consequences. Consider this fact, each year there is about 100,000 hospital acquired infections (HAIs) that could have been preventable. These HAI’s equate to the same number of deaths. Also consider that last year Medicare experienced 100 billion in Fraud, some of it accidental, but most of it not. It’ll be interesting to see how the ACA has affected our system in the years to come, but will it be enough or is it just a temporary solution to a deeper, underlying problem?

The answer to the question of how the system needs to be overhauled is not an easy one. I do know however that it will take strong people to stand up against the doctors, insurance companies, and profit driven hospitals, and ultimately do what’s right for the people. History has generated some great ideas, but opposition from strong political groups has prevented their arrival into the market. For the rest of us watching as two ships pass in the night, fasten your seatbelt and enjoy the ride, because it’s going to get bumpy.