Doctor’s Tip: What Obamacare did and didn’t do
During this time of political division and turmoil, it’s important to put politics aside and look objectively at what the Affordable Care Act (“Obamacare”) did to improve the health-care system in this country, and what it failed to do. A good way to get this information in more detail is to read “Mistreated, Why We Think We’re Getting Good Health Care — And Why We’re Usually Wrong,” by Robert Pearl, M.D., who is CEO of the Permanente Group and an expert in the business of health care.
First, it is important to review some basic premises:
• We have the most expensive health-care system in the world, yet we have poor health outcomes compared with other industrialized countries.
• Instead of a real health-care system, we have a disease management system.
• Many of our citizens remain uninsured and cannot afford adequate medical care.
• We reward quantity of health care (fee for service) rather than quality (good outcomes).
• Four legacy players, as Dr. Pearl calls them, benefit financially from the current broken system and therefore resist change: insurance companies, hospitals, specialty physician societies and pharmaceutical/medical device companies. They have undue influence in Washington.
• Our medical system is responsible for more than 250,000 deaths a year, the third most common cause of death.
• Our system is fragmented, with, for example, poor communication among the various components of the system and between doctors.
• The U.S. health care system “trails almost every other industry in the adoption of information technology.”
• “Mistreated” notes that “the quality of a patient’s care and his or her access to it varies dramatically based on such characteristics as race, ethnicity and socioeconomics.”
• Drugs and medical devices often are overpriced.
Presidents from both parties tried dealing with these issues for decades, but under Obama’s leadership, the gridlock was finally broken. Here are some of the positive things that the ACA did:
• Before Obamacare, 16 to 18 percent of Americans (50 million people) didn’t have insurance because they made too much to get Medicaid, couldn’t afford private insurance or had pre-existing medical conditions. Obamacare dropped the uninsured rate to below 9 percent. In particular, coverage was expanded for the poor through Medicaid, young adults up to age 26 are covered through their parents’ insurance and insurance companies must now offer affordable insurance to people with pre-existing conditions such as cancer.
• Medicare’s five-star system has moved enrollees into the higher-performing programs.
• Online exchanges have given health insurance coverage to 10 million people.
• Obama understood that in order to improve health-care outcomes and make health-care less expensive, a nationwide electronic medical record system was imperative, so the ACA offered financial incentives to physicians to install electronic medical records. Incentives were instituted to pay health-care providers for quality rather than quantity of services.
• Medicare was established in 1965 under President Lyndon Johnson. It is a socialized, government-run program that today is very popular among those who have it. At the time Medicare was being discussed, however, it was controversial, and it took 15 years to work out the bugs. Obama realized that the Affordable Care Act was not a perfect piece of legislation, but at the time, it was what was politically possible, and Obama thought that it would be tweaked in a bipartisan fashion as needed in the future.
Here are some of the failures of the ACA:
• Too many Americans remain without health insurance. Many progressives, such as Bernie Sanders, want a “Medicare for all” single payer, Canadian-style system to address this and many other health system issues.
• Although “computers are more prevalent in doctors’ offices today … improvements in patient care have been relatively minimal,” according to Dr. Pearl.
• The ACA set up Accountable Care Organizations to integrate the delivery of care, but so far they have failed to live up to their promise.
• In the U.S., drug and device companies fund two-thirds of all medical research. “Mistreated” notes that Obama “knew that to improve quality of life and control the expense of medical treatment for all Americans, we would need a better system for identifying, prioritizing and funding medical research.” Little has been achieved on this front under the ACA, however, due to push-back from these legacy players.
• The most important failure of the ACA is that so far our health-care system remains unsustainably expensive, and health insurance premiums are sky high. The ACA was designed to bring costs down over the long run, but Obama underestimated the political fallout of the short-term increase in premiums (witness the last election).
Next week’s column will discuss Dr. Pearl’s insights on where we should go from here to improve our health-care system and to make it less costly.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.