This is the third and final installment of my summary look at Obamacare (PPACA). Over the past year, I have looked at how Obamacare (PPACA) The Good and Obamacare (PPACA) The Bad have unfolded and am now ready to report on Obamacare (PPACA) The Ugly—just as the law is about to get thrown into the trash heap by the soon-to-be new President and the Republican-controlled Congress.
The Republicans have made it plain from the beginning that Obamacare (PPACA) was dead-on-arrival and over the past seven years have not moved to help Democrats improve it in any way. One can only imagine the healthcare situation today if the same had happened to Medicare legislation back in the early 1970s?
We will never know if Obamacare (PPACA) healthcare reform could have been a workable foundation for future healthcare reform because compromise and negotiation to improve Obamacare (PPACA) were never on the Republican agenda. So why am I even bothering to describe Obamacare (PPACA) The Ugly? The answer is quite simply because Obamacare (PPACA) The Bad and Obamacare (PPACA) The Ugly need to be addressed and applied in any new healthcare reform law. These problems will not disappear with a repeal of Obamacare (PPACA).
Obamacare (PPACA) The Ugly
Obamacare (PPACA) The Ugly permeates every sentence and subsequent regulation that makes up this healthcare reform law because they were written with the interests of for-profit healthcare businesses FIRST and with the interests of the American people SECOND. When government healthcare policy rests on the premise that “What is good for the financial advancement of healthcare businesses IS what is good for the nation”, then the delivery of high quality, affordable healthcare suffers. This is Obamacare (PPACA) The Ugly in action. A healthcare system cannot maintain BOTH high quality, affordable healthcare and high profits, bonuses, and incomes in the industry that is supposed to deliver it . As long as government healthcare policy ignores this reality, healthcare quality and affordability will only be words on paper.
Putting patients FIRST is a tall order in the United States because the concept of Money Rules is ingrained in our government’s actions. Americans in the United States are generally discouraged from seeking health care (especially costly care) unless they have enough money to pay for it. For people on Medicaid, the “best” health care is hard to find. People with high cost-share (i.e., deductible and out-of-pocket cost) and narrow network health insurance plans are discouraged from seeking health care until conditions and diseases are advanced and costlier to treat. If a person cannot pay for the “best” health care, they are expected to do without it. This is the American healthcare system.
Obamacare (PPACA) brought health insurance to many previously uninsured (over 10 million Americans), but as I described in my last blog post, it did not tackle the foundational healthcare system problems that are at the root of low quality, high cost care. Our government’s answer to high healthcare costs is to contain one part of healthcare costs (health insurance premiums) while letting another part rise (patient’s out-of-pocket costs). In other words, high healthcare costs were simply SHIFTED from those who do not use expensive healthcare (the healthy) to those who use expensive healthcare (the sick). Under this type of healthcare system, Americans must cross their fingers and pray they never get sick and the sick must shoulder more healthcare costs so that for-profit healthcare businesses can continue to enjoy high profits, bonuses, and incomes.
Governmental healthcare policy that works to keep health insurance premiums down by increasing out-of-pocket healthcare costs to patients is governmental policy that puts for-profit healthcare businesses FIRST and sick Americans SECOND. This is Obamacare (PPACA) The Ugly in action.
Under Obamacare (PPACA), the cost of subsidizing health insurance for non-group Americans (i.e. those who buy health insurance on the Healthcare Exchange) and the cost for the expansion of Medicaid was supposed to be funded through various fees and taxes. Through lobbying efforts by for-profit healthcare business, many of these fees and taxes have been pushed out to later dates. When these fees and taxes are not paid in a timely fashion, then the American taxpayer must shoulder the full cost of the subsidy.
This is government putting the interests of for-profit healthcare businesses FIRST and those of the American taxpayer SECOND. This is Obamacare (PPACA) The Ugly in action.
Healthcare businesses use various threats to keep healthcare costs high. Insurance companies threaten to leave health insurance markets that are not profitable enough or when they do not get financially-favorable legislation (e.g., Aetna) Medical doctors threaten to stop treating Medicaid or Medicare patients whenever the government makes a move to rein in high costs.
When our government gives in to these threats with favorable treatment, it is putting the financial interests of a particular industry FIRST and those of the American public SECOND. This is Obamacare (PPACA) The Ugly in action.
High quality healthcare is achieved in many countries around the world and, in each of these countries, the governments have recognized the need to put their people AHEAD of financial gain for one industry. In these countries, the healthcare workers and companies serve the people and not the other way around. For example, many of the patient-centered principles practiced by England’s National Health Service are documented in the NHS Constitution for England. These principles are spelled out below:
- The NHS provides a comprehensive service, available to all
- Access to NHS services is based on clinical need, not an individual’s ability to pay.
- The NHS aspires to the highest standards of excellence and professionalism
- The patient will be at the heart of everything the NHS does.
- The NHS works across organizational boundaries and in partnership with other organizations in the interest of patients, local communities and the wider population.
- The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources.
- The NHS is accountable to the public, communities and patients that it serves
None of these principles above are part of American government’s healthcare policy because in the United States, for-profit healthcare businesses are allowed to greatly influence healthcare policy for their own benefit. Even in a repressive dictatorship like Cuba, health care is constitutionally protected as a fundamental human right for ALL Cubans. Under this policy, Cubans enjoy comparable life expectancies and have lower infant mortality rates than Americans do. Are American citizens less worthy of high quality, affordable health care than every Cuban? Only when our government puts its people’s welfare above profit, will high quality and affordable healthcare be possible.
Obamacare (PPACA) The Ugly–Message For Future Healthcare Reform
Obamacare (PPACA) The Ugly will not go away when the Patient Protection and Affordable Care Act of 2010 is repealed next year. As long as governmental healthcare policy puts the financial interests of the for-profit healthcare industry AHEAD of the needs of the American people, the United States will never enjoy high quality, affordable health care.
Obamacare (PPACA) Part 1–“The Good” (December 29, 2015)
Obamacare (PPACA) Part 2: “The Bad” (January 4, 2016)