This article was first published on The Huffington Post on May 29, 2013 as "The Affordable Care Act Accident"
Those who support the Patient Protection and Affordable Care Act (ACA or "Obamacare") see it as a landmark victory for Democrats in their pursuit to provide more equitable health care to all Americans.
I see it as an accident that happened because Ted Kennedy died.
The American health care system is broken and quickly heading towards insolvency. For decades, politicians, from Hillary Clinton to Ted Kennedy himself, have been trying to address this national imperative. Sadly, the concepts in ACA are not the culmination of these years of thoughtful investigation. Yet the bill passed due to a perfect storm of public dissatisfaction, President Obama's landmark election, and... the death of arguably health care reform's biggest proponent, Ted Kennedy.
Ted Kennedy died on August 25, 2009. President Obama signed ACA into law on March 23, 2010. The timing is not a coincidence.
Congress was emotionally impacted by the death of the "Lion of the Senate" and some members had to have voted for the bill as a tribute to this respected man. There is no other explanation for why a bill that is so vilified today could have been passed so recently. Although one could argue that it's taken about three years to actually read it.
I should love Obamacare. I'm a single mother of two who has to shop for health insurance on the open market. But I was also a consultant to the health care industry, so I've seen how the system functions from the inside out. There's no doubt that the health care industry has been bullied by the insurance industry. This has resulted in unsustainable administrative costs and a reduction in focus on patient care. Obamacare takes the most disgraceful assortment of deplorable rubbish imaginable mangled up in tangled up knots, and makes it even worse.
How did it all start? "The precursor to Blue Cross was founded in 1929 by a group of Dallas teachers who contracted with Baylor University Hospital to provide 21 days of hospitalization for a fixed $6.00 payment. The Baylor plan developed as a way to ensure that people paid their bills." In other words, health insurance was a pre-pay system. It was beneficial for hospitals to negotiate a volume discount to make sure that they were paid.
Over the decades, insurance organizations, and that includes the U.S. government with its Medicare and Medicaid programs, have advanced the concept of bargaining for bulk services and supplies to dizzying heights. As a result, providers ramp up their stated costs so they can start their negotiations high, and then, hopefully, come down to a level that will keep them profitable. Anyone who's seen a hospital bill knows what I'm talking about.
Unfortunately, given the current structure of the system, there simply isn't enough money to go around to give every one of us world-class medical attention. Financial waste in the health care system should be seen as a national crime. Yes, Obamacare has provisions to target fraud, but financial waste comes in the form of many sources, including medical errors, billing errors, price inflation and inefficient service delivery.
Our health care costs will continue to skyrocket because we have a reimbursement system based on doctor visits, tests ordered, and procedures completed. Both doctors and patients rely heavily on pharmaceuticals, not diet, exercise or lifestyle changes, as the routine strategy to cure all that ills us. The practice focus -- and the payment incentive structure -- must shift from disease treatment to disease elimination. If the overall health of Americans improves, health care costs will come down.
Many believe that Obamacare will improve the health of Americans. ACA dips into the clinical side by penalizing hospitals for re-admission rates, despite the limited control that hospitals have on the factors that lead to a patient's return. Obamacare does little to provide health education to the public, nor does it reward or penalize patients for their behavior. Its main achievement: ensuring that access to our existing, defective health care system is expanded to everyone in the nation.
We are all frustrated. But frustration shouldn't lead to desperation. As the bill moves into implementation, the painful, bureaucratic realities of its enormity will fuel the fire of those opposed to the bill, and convert those who had been duped into supporting it from the get-go.
Obamacare is the gangrenous limb on the ailing body of the American health care system, and it needs to be cut off. It's the first step to improving the health of the nation.
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