By Roy Benaroch, MD
With the Supreme Court’s decision to uphold the central portions of the Patient Protection and Affordable Care Act (often called “Obamacare”), the legal struggles over the legislation are largely settled. It’s now time to focus on the implementation of this complex set of laws. State and federal administrators and lawmakers ought to focus on helping to make the law meet a few simple goals.
Lost in the recent headlines is the underlying issue, one with which I believe most Americans agree: there are significant problems with the delivery of health care in the United States. Access for many is restricted, and insurance companies have been able to hold all of the cards. By excluding preexisting conditions, insurance companies have been able to ensure that the people who most need health insurance may be been unable to get it. The biggest problem, though, is that health care is just too expensive. Premiums are huge. Whether paid directly by you or indirectly through your employer, someone is paying, big time, and it’s not clear at all that we’re getting good value for our money.
So what will the law do to solve these problems? Access to health insurance might improve, as the mandate for everyone to buy health insurance is paired with laws that disallow the exclusion of people with pre-existing conditions from health care plans. However, just having more people on insurance rolls won’t actually make it easier to see doctors, unless there are more doctors and offices and open hours and appointment slots. Some ways to do that would be to reduce the expense of a medical education, provide increased incentives to primary care physicians (that is, pay more), or provide alternative health care access through clinics or non-MD physician “extenders”. Providing access to insurance is good, but it isn’t the whole picture. In fact, unless something is done to increase the pool of health care providers, having more people jostling for the same number of appointments might actually make it harder to get in to see your doctor.
The health reform law, as it’s currently being discussed and implemented, doesn’t seem to do much to help control the cost of health care. There’s no provision to help address malpractice reform to reduce unnecessary “defensive medicine”, and there are no meaningful provisions to reduce wasteful ER visits or the use of unnecessarily expensive medicines or tests. Unless costs are controlled, more people with government-organized insurance will only bankrupt us that much sooner.
Implementation of health care reform will be a complex task, and it’s difficult to look ahead at the ramifications of this sweeping legislation. I urge lawmakers to keep a few, simple principles in mind. Access to affordable, quality care should be the goal of health care reform.