Health Care Reform: The Good, the Bad, & the Ugly

Health care reform, also known as the Affordable Care Act of 2010, could probably be considered one of the largest inter-country controversies since the Civil War. The Civil War certainly divided the nation into blue and gray, and today, the ACA has again divided us by blue and red. But, is this really necessary? Is the ACA really as bad as some strongly believe or as fantastic as others vehemently argue?  While the ACA and associated legislation is not necessarily a light read, there are a few elements that separate out the good, the bad, and the ugly.

In a presentation I attended on health care reform, leading legislative health affairs expert and President/CEO of Grinnell Regional Medical Center in Iowa Todd Linden noted that the Act has some long-awaited improvements to America’s healthcare system. First and probably the most important issue comes in the form of improvements to insurance access. Basically, this act forbids insurance companies to deny coverage for people with pre-existing conditions.  Second, the Act extends coverage to millions more people who could neither obtain nor afford health insurance in the past.  (Note: Some reports claim that number is 32 million, others claim it to be much lower…regardless, the Act does extend coverage to uninsured.)  However, in a country that claims to be one of the richest nations in the world, we should feel ashamed that a large number of our residents do not have basic healthcare benefits in some form or another. This Act provides the extended coverage that should have always existed to enhance the health and well-being of this nation’s people. Third, the Act truly focuses on wellness and prevention. From a public health viewpoint, the wellness/prevention focus is a positive change that has the potential to reduce the prevalence of diseases such as obesity, diabetes, cardiovascular disease, and other behavioral-related illnesses. In turn, this disease reduction will lower overall medical costs.

The ACA is not all positive, and the bad portions are just as abundant.  As one example, the ACA leads us down a road of significant reductions in Medicare payments and reimbursement rates for thousands of healthcare providers.  Medicare covers health needs of senior citizens, a growing population throughout the country. In Crawford County, this reimbursement reduction will significantly affect the number of services that can be offered at hospitals, nursing facilities, and through other elderly care programs. While on the positive side, the ACA expands coverage to young Americans, but on the negative side, it decreases coverage for the fastest-growing population in America – our senior citizens. Thus, the ACA seems to be avoiding the needs of the Baby Boomers, who will eventually be utilizing the majority of the health services across the nation. Another bad element of the ACA is the requirements now imposed on all hospitals (regardless of their size). A listing of all the new mandates for charitable hospitals is published online at www.healthreformgps.org, a joint project of The George Washington University’s Hirsh Health Law and Policy Program and The Robert Woods Johnson Foundation.  One of the mandates requires hospitals to invest in a Community Health Needs Assessment every three years. While community health needs assessments are important in order to provide the most necessary services for the community, should they really be required and required every three years?  Assessments can cost upwards of $100,000 – money that will most likely be pulled from services and programs in order to assess the county’s health every three years. The Health Reform GPS website lists many more mandates that could be extremely costly to smaller, non-profit hospitals who often cannot afford to perform such tasks so often.

Finally, the ACA does contain some pretty ugly concepts. The worst, and the issue that is creating the most controversy, is the argument that this law moves us closer to becoming a socialistic system, breaking down the concept of the capitalistic system for which America is known. Healthcare for everyone – especially free care – is a socialistic concept. Those who can afford healthcare will pay for those who cannot, generally through an increase in taxes (which is forthcoming).  Isn’t this one form of wealth redistribution more commonly found through socialism? A second and just as equally ugly concept is the cost of the ACA along with all of the Health Care Reforms that came with it. The Congressional Budget Office claims that the ACA and associated reforms will reduce the deficit over the next 10 years. Yet, Mr. Linden and many others (including economists, politicians, and health professionals) have indicated that this reform will cost more than $1 trillion. In a country that is failing miserably in lowering its current deficit, we cannot afford to take on any more debt let alone handle a $1 trillion invoice to pay for an act that is stirring up a new kind of war…one that will debate the healthcare reform…all of it: the good, the bad, and the ugly.

References:

Congressional Budget Office. (2010). Selected CBO publications related to health care legislation, 2009-2010. Retrieved January 4, 2011, from http://cbo.gov/ftpdocs/120xx/doc12033/12-23-SelectedHealthcarePublications.pdf.

Linden, Todd. (2010). Presentation titled “An Objective Look at the New Healthcare Legislation.” 295 Attendees; Presented Dec. 7, 2010 from Grinnell Regional Medical Center, Iowa.

Rosenbaum, S. & Margulies, R. (2010). New requirements for tax-exempt charitable hospitals. Retrieved January 4, 2011, from http://healthreformgps.org/resources/new-requirements-for-tax-exempt-charitable-hospitals/.