“Rammed through Congress” after a year and a half of deliberations and seventy-nine congressional hearings, the Affordable Care Act has covered millions more of us. Now, after sixty knowingly futile attempts to repeal it, no viable replacement yet in sight, and just one hearing, we are being asked to believe promises to cover everyone at less cost will be kept.
This will likely take more time. Very few of us agree with Paul Ryan that 24 million losing coverage to save $300 billion over a decade “exceeds expectations.” Conservative Wall Street Journal columnist Peggy Noonan has surprised us. She has had enough and has recommended that Medicare be made available to many, many more of us.
We have made progress, though. Millions more of us have coverage, for now; and some health care costs are down; but there is clearly work to be done as long as better outcomes are delivered in other nations at less cost.
The National Academy of Medicine and Health has suggested that unnecessary care may account for up to half of our costs. We do know that no other nation performs surgical procedures at our rate. Cardiac bypass surgery also costs twice as much here as in Canada, although our clinical outcomes are virtually identical. Life expectancies are longer in Canada, too.
In 2009 our nation’s highest per capita Medicare costs were found in Miami, Fla. The population of second-place McAllen, Texas, better reflected our demographic average, and yet McAllen was spending double our nation’s average. Litigation was suggested as a cause, but a law limiting awards for medical damages had been passed, and lawsuits for malpractice had become nearly nonexistent in Texas.
They were doing more, but primary care was being overlooked. By 2011 the Affordable Care Act was encouraging any physician’s group with more than 5,000 Medicare patients to become an Accountable Care Organization, prioritize patient outcomes, and receive bonuses for the savings they produced.
Focusing more upon primary care and patient education, McAllen moved in a positive direction. By 2014 its ACOs had saved $26 million, 60 percent of which went back to the participants.
Health care insurance premiums were growing at slower rates than during the Bush administration, too, until it became clear that insurance doesn’t work efficiently when purchased only by those who need it.
Repealing the individual mandate is on the agenda now, and we have been advised that we might have “more skin in the game.” Our health care already costs us more, though, and prices aren’t likely to go down as long as we are driving farther to see fewer doctors less frequently. NationMaster finds proportionately more physicians in 51 other nations, and they are seeing their patients more often.
Having choices and a level playing field helps control prices, but when it comes to health care we may not only find ourselves with limited choices, we may not be up to the task of shopping around. In such cases oversight may be required. This is the role of government, and it’s up to us to make it work.
Concerning the repeal or reform of the ACA, President Obama has stated clearly, “If it works, I’m for it.” As long as patient outcomes are prioritized and more of us are covered at less cost, he welcomes change. We might let our representatives know that we would like them to move beyond ideology, work together, and do what works. Becoming a healthier nation at less cost is in all of our best interests.
Looking beyond our borders to see how things might work may be a leap, but hundreds of thousands of us are going abroad for more affordable care. Too bad we aren’t permitted to buy our medications abroad. That would bring our costs down, too.
Lower administrative costs would also be helpful, and for that we need look no further than our very own single payer base with private options. We love our Medicare. Allowing more of us to choose it would be a start.
Carol Voyles of Sherwood is treasurer of the Talbot County Democratic Central Committee and a board member of the Talbot County Democratic Forum.