At the time of this writing, the United States Supreme Court is considering the constitutionality of the Affordable Care Act (the ACA or Obama-Care). It has now been two years since this legislation was signed into law. I have noticed some small positive changes like children staying on their parent's insurance plans longer and the elimination of pre-existing conditions as a reason to refuse health care coverage. However, health care in the United States seems to be just the same business as usual.
Business as usual includes out of control health care spending. We pay more per capita than any other country in the world for health care (almost twice as much as Taiwan or Great Britain), but with worse outcomes. Almost one third of the health care dollar is wasted on things that have nothing to do with health care: underwriting, advertising, denying claims, paperwork, advertising, bureaucracy etc.
Our emergency rooms are still burdened by sore throats, coughs, and asthma treatments that are more appropriate for a family practice office setting. People are still dying everyday from lack of health care. There are still millions without insurance and without access to basic medical and dental care.
Furthermore, the ACA does nothing to address the problem of underinsurance, which continues to increase. Underinsurance occurs when you have medical insurance, but the deductible is so high (or the coverage so poor) that you can not afford medical services.
The Supreme Court is considering repealing the ACA clause that will force us all to buy health insurance. If the court doesn't repeal this part of the law, then people caught in the middle will have to pay a fine for not having insurance. That fine would not be fine with me. Isn't this just another forced bailout of a dysfunctional industry? What happens to all that money we are being forced to pay for high deductible plans that don't provide much medical care? Won't some of that money just end up padding the profits and million dollar CEO salaries of the insurance industry?
There has been a lot of political commentary lately regarding fixing or repealing the ACA. The usual political prescriptions encourage saving money by cutting programs, cutting health benefits, or increasing personal responsibility with plans like health savings accounts. However, I think that pill is too bitter to swallow. We can do better than that.
There is another side of the story that we aren't hearing. We can save money and decrease health care spending simply by making health care a human right. It sounds too good to be true, but other countries do this and the world hasn't ended.
I hope people will start talking about how Vermont Governor Peter Shumlin signed Green Mountain Care into law last year. The trail blazing health insurance legislation aims to make Vermont the first state to provide health insurance for all 620,000 residents. This legislation replaces their complex multi-layered insurance bureaucracy with a single insurance payer. Green Mountain Care can not be fully enacted until 2017 because of restrictions in the ACA (another thing I don't like about the ACA).
What is so great about Green Mountain Care? How does covering everybody for all necessary medical care and saving $500 million sound? It sounds a lot better to me than the ACA. In a day and age when most people agree health care costs are not sustainable, Green Mountain Care exclaims, "Everyone in, nobody out!" When president Obama excludes single payer from consideration, Green Mountain Care answers, "We have earned a seat at the table!"
So what is my prediction about the ACA and the Supreme Court? Will they strike down the entire law or just parts of it? My answer is that it doesn't matter. It truly doesn't matter because the ACA doesn't fix our health care mess.
I hope we will stop talking nonsense about the ACA and begin talking about health care as a human right. I hope Minnesotans will march in parades, give speeches, and knock on doors in support of health care for all. I hope the sick everywhere can one day get treatment. I hope my children will never know the pain of being uninsured. I hope for a more just and fair world. Oh yes, I hope.