What will come next?

Alternative Medicine - - News - BY JOHN GEY­MAN, MD

Six years af­ter the Af­ford­able Care Act was passed, John Gey­man, MD, takes a look back at the suc­cesses and fail­ures of the Act.

IT HAS BEEN SIX YEARS since the Af­ford­able Care Act (ACA) was en­acted in 2010 amid much fan­fare and con­tro­versy. This com­plex leg­is­la­tion, built on our present multi-payer fi­nanc­ing sys­tem, promised that we would be able to keep our own doc­tor and in­surance if we so de­sired, and the qual­ity and af­ford­abil­ity of health­care in this country would im­prove.

Dur­ing this 2016 elec­tion cy­cle, the ACA is still mired in con­tro­versy as com­pet­ing po­lit­i­cal in­ter­ests ei­ther sup­port it or call for its re­peal. In any case, the key ques­tion arises— what will come next?

It is be­com­ing clear that pa­tients, fam­i­lies, em­ploy­ers, and the govern­ment can­not af­ford the con­tin­u­ing, un­con­trolled es­ca­la­tion of health­care costs with so much bureau­cracy, waste, and even fraud within the sys­tem. Na­tional health­care spend­ing reached $3 tril­lion in 2014, mean­ing the United States now spends more than $9,523 per capita per year on health­care, com­pared to an av­er­age of $3,454 for other Or­ga­ni­za­tion for Eco­nomic Co­op­er­a­tion and De­vel­op­ment (OECD) coun­tries. And the sit­u­a­tion is only go­ing to de­te­ri­o­rate. Health spend­ing is pro­jected to in­crease by an av­er­age of 5.8 per­cent an­nu­ally for the next eight years. Th­ese costs are not sus­tain­able, and still cost con­tain­ment is nowhere in sight.

For starters, all of our pa­tients would be cov­ered re­gard­less of their age, em­ploy­ment sta­tus, or where they live in the country. We could ask pa­tients when they first come to us, as we used to, “How can I help you?” in­stead of to­day’s first ques­tion about what in­surance they have. The sys­tem would shift from a busi­ness ethic to­ward a ser­vice ethic. For-profit fa­cil­i­ties would tran­si­tion to not-for-profit sta­tus over a 15-year pe­riod. Health­care pro­fes­sion­als would be paid on a ne­go­ti­ated fee ba­sis, while hos­pi­tals and other fa­cil­i­ties would be re­im­bursed through an­nual global bud­gets. An­other nec­es­sary el­e­ment will be the cre­ation of a na­tional body, in­de­pen­dent from po­lit­i­cal in­flu­ence, that de­cides what ser­vices should be cov­ered and re­im­bursed based on sci­en­tific ev­i­dence. There are good ex­am­ples of such a body around the world, such as the United King­dom’s Na­tional In­sti­tute for Health and Care Ex­cel­lence (NICE).

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