PROMISES VS. REALITY OF THE AFFORDABLE CARE ACT
What will come next?
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).