The US Healthcare Disaster

The Affordable Care Act sits precariously as the US healthcare delivery scheme. The Act brought the US kicking and screaming into the modern world with a large ethical and moral step forward. Our “exceptional” country was exceptional about healthcare but in a third world way.

Healthcare prior to ACA was marked by the label, “the best health care money could buy” and sported an out of control cost for delivering healthcare.  And best of all, not all Americans got healthcare.

Under pre-ACA conditions, an estimated 50 million Americans were without healthcare coverage. Some chose to skip insurance coverage (saving money) while most simply could not afford coverage or were denied it (pre-existing condition). In an enlightened country, one wonders how that could have been?

The answer lies mainly in two places. Most Americans were (and still are) insulated from healthcare delivery costs. Employers picked up most of the premiums and the average American simply did not see the need to question the healthcare delivery system. The second aspect of pre-ACA was the American Healthcare delivery system was a “for profit” enterprise with generous government support (namely Medicare and Medicaid) and seemed to have no ethical or moral conscience about whether the average person could afford basic coverage.

So what is different with the Affordable Care Act?

ACA strikes at the unfairness of the 50 million uninsured and does set up some strategic changes in how medical costs are generated. The individual mandate has helped prevent many Americans from “gaming” the system, skipping insurance while they are healthy and using Emergency Rooms if they do get ill. ACA also increased requirements for businesses to provide coverage, insurance companies can no longer deny coverage for “pre-existing” or “extreme” illnesses, and “exchanges” were established to make available a wide range of insurance products which could be coupled with subsidies if the individual met certain income measures.

Despite ACA’s attempt at reforming how healthcare is delivered, the Act did not change the “for profit” orientation. So it should not be any surprise that healthcare costs continue to rise at breathtaking rates. Most doctors and hospitals are simply passing on increased costs and dragging their feet on any real structural changes. Drug companies who kept their ability to charge Canadians less for the same drugs as US citizens, have in a growing number of cases, raised the price of life saving drugs to unconscionable levels.

So to celebrate the Affordable Care Act, one must be careful about what one is complimenting. ACA is clearly better than what came before it, but there is a glaring deficiency with what are world class healthcare systems deliver.

So with every Republican Presidential candidate positioning themselves to repeal and replace ACA, what would one think their justification might be and how would they reform it?  Hmmm.

All candidates, in one way or another, say ACA is too costly and we can’t afford it.  A simple repeal means no more exchanges and no more expanded Medicaid services. It also means a return of insurance denying coverage for “pre-existing” conditions and being free to put a cap on benefits in catastrophic illnesses.  With the GOP it will be back to “the best healthcare money can buy”.

This is not world class.

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Explore posts in the same categories: 2106 Presidential election, affordable care act, congress, democrats, GOP, Healthcare, Politics, republicans

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