As I have reported, and one of my sons mentioned to me in this morning's phone call, I have plowed my way through 906 single-spaced pages of the Patient Protection and Affordable Care Act ("ACA") which President Obama signed last March. I have read numerous blogs (including those of the Director of the Congressional Budget Office which, being written for Congress people and their staffs, are written clearly) some of which demonstrate complete unfamiliarity with the actual text and meaning of the ACA. I am convinced that many public statements about the ACA reflect uninformed for personal-profit political positions more than hard time-consuming actual work to understand and think about the act.
A disclaimer - I have my biases. As a physician specialist, I took care of very sick people, never turned anyone away because of insurance status or lack of it, and have no respect for those that do. I have a large family which has seen more than "its share" of sickness and disease and death and my family has been significantly impacted by our severe recession. I have been the Chief of Staff of a large mid-city hospital, now closed and abandoned, and have seen what economists call "dislocation" and the rest of us call bankruptcy in health care. I have seen excellence and incompetency in health care and the systems which deliver it. I was a member of Stanford University's clinical faculty, providing one morning a week of unpaid time for thirteen years, taking care of veterans with blood diseases at the Palo Alto VA hospital and teaching medical students, residents and hematology fellows. As a member of a powerful well-financed state hospital industry board, I have seen political and economic jousting within and outside the hospital industry. When I practiced health law, among others, I represented a large medical group and was heavily involved in the analysis and negotiating of managed care contracts as well as contracts among physicians and their practice entities.
Bottom line - if health reform is repealed we will be worse off. The good outweighs the rest.
The ACA will provide access to insurance for Americans who have lost employment and their families' health insurance and don't have enough money to buy Cobra extended coverage. The ACA outlaws insurance company abuses and will provide health insurance and care to our kids and grandchildren. The ACA will provide incentives to employers to sign their workers up for insurance, insurance which cannot be rescinded or be subjected to unreasonable annual coverage limits or lifetime limits. The ACA will expand Medicare coverage for Part D beneficiaries although there will be a modest increase in premiums over the next ten years and it will even help seniors to stay out of nursing homes, or if in nursing homes, have better quality of care (Also see the Elder Justice Act within the ACA at pages 664 and following) The ACA will improve access to care in rural and underserved areas and the care of the poor. It will train doctors, nurses and others in the health professions without burying them and their families in debt. It incorporates an "Elder Justice Act" which may safeguard seniors against some of the terrible things that I saw happen to my older patients. It has strengthened protections against fraud and abuse. And, it encourages advances in medical inventions, products and care which moves us into a new generation of health services.
The projections are that it will save about $14 billion dollars each year for the next 10 years and thus control the rise of premiums and out-of-pocket expenses that each of us experiences each year. And interestingly, it will make it possible - through support of America's families and children - to grow our workforce so that in coming there will be young working people able to fill the jobs that America offers and help America's businesses.
My study indicates that health reform is good for families, good for working-people and those who would work if they could find work, good for America's supply of doctors, nurses and health care workers, good long term for large and small business and less costly than the alternative - no health care reform.
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4 comments:
http://seekingalpha.com/article/194608-how-much-does-healthcare-reform-cost
I agree that we need to fix a lot of things in the Healthcare system. There are many aspects that do not work well.
We have proven that the MediCare/MediCaid systems are going broke at a breakneck pace. There are 2 things that the Republicans wanted in HC reform that were not included at all - Interstate competition and Torte Reform (sorry Dan).
There is no reason to believe that this law will cover more people at a lower cost without having significant effects on the entire system. It is designed to collapse and lead to a single payer system which nobody wants to discuss.
Currently, insurers are raising rates, stopping to offer certain policies (child-only), dropping companies (McDonald's), and leaving the business all together (Progressive Insurance). The profitability of these companies are among the lowest of many of the Fortune 500 - single digits in many cases.
As far as savings to the budget, the CBO score is based on a 10 year projection. The 10 years started when the bill was signed. The bulk of the benefits start 2014 - 10 years of taxes and 6 years of coverage. What happens the next 10 years when there won't be a 4 year savings to leach off? The law also did not included the "Doc Fix" - a ($300 Billion cost that was supposed to reduce medicare reimbursements). The bill also added in the student loan program - a $370 Billion credit to the law. Why? Why would they score the law without the doc fix and with the student loans? To make it look like it was fiscally responsible, which, it is not. Where has the CBO ever scored something that came in on or under budget?
As far as "the good outweighing the bad", the only think we can look at is other countries that have tried this and assume they are better at it as they have been trying it for decades. Are they better? Have we learned what will work and what will not? It is important to see how a similar fix has worked in the rest of the world. Canada, UK, and others systems are failing and costing much more than budgeted - care is being withheld for patients regularly and wait times are unacceptable by US standards.
So I must ask, do you think the Republicans wanted to do nothing? Not change a thing? They very much wanted to change things but were shut out of the meetings (that were supposed to be televised on C-SPAN).
I think one of the biggest problems is the characterization that Conservatives want to harm people. That only serves to divide our country. The left has villanized the right so much that they were not even worthy of being listened to with regard to much needed changes. The closed door meetings and back room deals have left the American people disgusted with the entire process.
In the Republican Pledge, ACA Repeal is listed. That doesn't mean they want to go back to the past - they want to improve the system as well, just not in the same way this administration has.
Henry,
I thoroughly agree with your analysis. And I applaud you for tackling the actual text. I think my biggest disappointment with the Obama administration, re this act, was that they did a terrible job selling it. I saw many polls show support for the act when it was broken down into its individual parts. I think they would have had much more overt support if they had spun the act as "Health Insurance Reform" which it is, in fact.
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