Affordable Care Act ‘is a long overdue step in the right direction’

To the Editor,The following response to Mr. Madison’s letter of 10.31.2013 is based on fifty-one years experience working as a practicing physician, medical administrator and medical school faculty member. Mr. Madison’s comments, like most opponents of the Affordable Care Act (ACA), fail to address the dismal state of the American health care system.Over 100 years ago Theodore Roosevelt campaigned on a Republican platform calling for healthcare for all Americans. Sixty-one years ago President Truman in his State of the Union address called for universal healthcare. Forty-one years ago President Nixon unsuccessfully worked to establish healthcare coverage for Americans. The results of these efforts have been Medicare and Medicaid passed in 1965 with similar predictions of disaster and naysaying. That’s it. We still had fifty million uninsured and twenty-five million underinsured citizens in the twenty-first century (Washington Post, June 25, 2012).So the question really is, what do we as a nation do about these seventy-five million citizens? The need for other than routine healthcare is most often unplanned, unanticipated and very often very expensive. Emergency Medical Treatment and Active Labor Act (EMTALA) legislation, professional ethics and morals require treatment be provided for those needing it, even though the treatment may be delayed, limited or substandard due to financial constraints. For a variety of reasons an expectation of payment for these services is expected and necessary.Mr. Madison objects to the costs attributed to implementation of the ACA. Perhaps he and others like him could better spend their time complaining about and demanding correction of the waste in the healthcare system. Millions of dollars are spent just on administrative costs, i.e. costs incurred by insurance companies, the government, physicians, hospitals and businesses determining who is going to pay and how much. According to an Institute of Medicine (IOM) report there are 750 billion dollars wasted in the American healthcare system annually (IOM, Best Care at Lower Cost, 9/6/2012). This is nearly one-third of the two and a half trillion dollars spent annually on healthcare in America.Another concern registered by Mr. Madison relates to “care rationing.” It is here now and has been for years. For many years insurance coverage for hospitalization (most all plans) is only for a predetermined number of days. Check your prescription coverage and I bet you it doesn’t cover all prescribed medications. Arizona for a period of time denied organ transplant coverage for Medicaid patients. This is rationing.Mr. Madison indicated the ACA was a “redistribution of health.” Tell me what healthcare is taken from anyone to provide healthcare for others? The ACA provides healthcare insurance coverage for those who lack it but does not take anything away from anyone. What it does do is require everyone to have adequate healthcare insurance, which many current policies do not. This may require some folks to change their policy so it meets the minimum requirement.“The Obamacare wreck was shoved down our throats” is another claim by Mr. Madison. Well, hearings were held, lengthy debate had in congress, changes made, judgment by the Supreme Court and a national election with the ACA as a main topic of discussion. Hardly shoved down our throats.“So Obamacare has blown up the best health care in the world…” claims Mr. Madison. Mr. Madison confuses (as do many others) healthcare with the healthcare system. Primarily, it is the American system of healthcare delivery, which performs so dismally and which the ACA addresses, although there are also problems with the care itself.The United States does not fare well in comparative measures evaluating the healthcare systems of nations. World wide the United States ranks forty-sixth in life expectancy, less than fifteenth in male life expectancy, less than seventeenth in female life expectancy, (The Economist, Pocket World in Figures 2014, pg. 80), lower than tenth in infant mortality, (World Health Organization). Medical expenses account for over fifty-percent of personal bankruptcies. It is estimated 1.2 million Americans sought medical care overseas in 2012 (medical tourism) due to the high costs of care in the U.S.The ACA ends discrimination for pre-existing conditions, end high out-of-pocket expenses, deductibles or co-pays, ends cost sharing for preventive care, end coverage dropping for serious illnesses, ends of lifetime caps on coverage, ends gender discrimination, extends coverage for young adults, and guarantees insurance renewal. Doesn’t sound like too bad a plan to me.Much yet needs to be done to improve both the ACA and our healthcare delivery system but on balance the ACA is a long overdue step in the right direction. We just need to maintain the momentum.Chuck Gehrke, M.D.Tecumseh

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