What alternatives to health care have critics of ACA offered?
To the Editor,
The rollout of the Affordable Care Act (ACA) has been an unmitigated disaster causing untold inconveniences, disappointments, and represents a failure on the part of the government and the current administration. Presidents Obama’s inaccurate and misleading explanations regarding currently owned healthcare policies were a significant error and reflect very poorly on him and his administration. Both of these breaches of public confidence have been acknowledged, owned and amends (solutions) offered. Ordinarily this is what is expected of and accepted from those guilty of such breaches, which are not related to the intended purpose of the ACA.
A great deal of time, effort, and energy has been and likely will continue to be expended presenting and rebutting specific points regarding the status of the healthcare system in the United States. This is evidenced by both the national and recent local discussion of the (ACA). Little is gained with this type of discussion since the questions are endless and the answers controversial or provoke more (often irrelevant or distracting) questions. Until the discussion addresses and answers several basic questions regarding the American healthcare system any other discussion is of little value. Actually, any other discussion is less than valueless; it does harm in that it distracts from and avoids discussion of the basic issues.
The first question is: does a nation have the responsibility to provide equally, the same essential healthcare services to all of its citizens irrespective of social or economic status? The overwhelming majority of experts regarding satisfactory healthcare systems agree the three elements of such a system are adequate availability of, reasonable access to, and affordability of services. The second question then becomes: does the current American healthcare system provide these three features? When we have directly answered these questions then all the other issues have a context within which to be addressed.
Most who support the ACA believe the answer to the first question is yes and the second no. Additionally, they believe the ACA falls far short of the ideal but is the first step in many years (forty-eight) towards reaching these goals. I may have missed it (I doubt it) but I have as yet to hear any meaningful alternative solutions suggested to the current healthcare delivery system in the U.S. that meet the criteria noted above, only criticism, often inaccurate, misleading, or distracting.
So the challenge to the critics of the ACA is: what alternative solutions to discrimination for pre-existing conditions, high deductibles and co-pay, gender discrimination, lifetime caps on coverage, coverage for young adults, guaranteed insurance renewals will you offer that meet all three of the criteria noted above?
To illustrate the distracting or misleading nature of the questions or criticisms regarding the ACA let us look at three points raised by Mr. Madison’s letter of November 14, 2013.
First, he asks why the ACA does not address health care fraud and abuse? It does by increasing sentencing guidelines for healthcare fraud, enhanced screening of providers and suppliers, and increased use of advanced predictive modeling technology. In the past three years the U.S. government has recovered $10.7B in healthcare fraud. (U.S. Dept. of HHS and U.S. Dept. of Justice). How much has the private health insurance industry recovered?
Second, Mr. Madison asks if the ACA will impact smoking, obesity, and risky behaviors? I will assume for the moment “risky behavior” includes illicit drug use and drinking. The answer is yes. The ACA provides for increased employer penalties (fines) on employees who do not participate in company wellness programs or meet health targets. For the first time the ACA includes treatment for mental illness and addiction as an essential medical service with payment parity compared to medical and surgical services. (Huff Post Business, 11/17/2013).
Last, he indicated breast cancer cure rates are less to England and Canada than the U.S. due to delay in treatment and limited physician availability. Cancer statistics are one of the most difficult to accurately compile and interpret of any medical statistics because a multitude of factors influence disease outcome. Delay in treatment is but one and is also a factor in many areas of the U.S., as is the availability of physicians. How much, if any, is the difference in outcomes between rural and poverty stricken areas of the U.S. where both these problems exist and these countries? In the U.S. 40 percent of sicker adults report difficulty seeing specialists (e.g. oncologists writer’s addition) because of long waiting times, 31 percent because of denied referrals or waiting for a referral, 17 percent because they cannot afford private health insurance. (New England Journal of Medicine, 10/28/2009, pg. 1803). Other factors impacting breast cancer survival are age at diagnosis, race, ethnicity, disease stage at diagnosis, cell type of the cancer, and the socioeconomic status of the patients. (Breast Cancer Facts and Figures 2009-2010, Am Cancer Soc.). Are these all similar in each country?
Each of Mr. Madison’s contentions can be addressed in a similar fashion and the counter point assessed by the reader with no context until we have answered the questions posed in the opening paragraphs. As one of my mentors often said, “The world is filled with problem finders (critics —writer’s addition) but there is a critical shortage of problem solvers.” We need more problem solvers!
Chuck Gehrke M.D.