Whether you are 
celebrating or upset, it is clear that for the moment the Affordable Care Act is the law of the land. Americans, liberal and conservative, have significant reservations for numerous different reasons.
For many it is the cost. For those with Medicare, it may be concerns that their benefits will be reduced to meet the health care needs of the uninsured. Others worry that the law will ruin the best health care system in the world. (If only that were true. The health of Americans ranks last among developed countries.)
There is consensus about what most of us favor. Almost universally we believe that young people who are in school or working in jobs without insurance should remain on their parents’ insurance until they are 26.
We believe that no one should be denied access to insured care because of the presence of a pre-existing condition. This is a no-brainer. Pre-existing conditions make movement from one job to another difficult. And for those who lose a job, getting re-employed becomes impossible. Most agree that all children need preventive care and if they become ill, deserve adequate medical treatment.
In Arkansas, the percentage of our residents who are disadvantaged and poor is very high. Many are gainfully employed and hardworking but currently have no access to affordable health care insurance.
These people have a shorter life expectancy, suffer from many chronic diseases, and go to the emergency room too often for minor problems and too late for serious ones that can lead to financial ruin and more. Paradoxically, being uninsured and ill is very costly. For these reasons, it is fair to say that, no matter our status in life — rich or poor, young or old — as long as we are Americans, being healthy and productive is a good goal.
The opposition to the Affordable Care Act boils down to the cost. States are balking at the extra billions they will have to spend on Medicaid. Lobbyists are working to assure that their special interest groups continue to generate current revenue or more from health care and that there be no attempt to reduce the amount paid for any medical services.
I am sure there are other financial reasons for concern and like most of us, I do not understand the full economic implications of the Affordable Care Act. I do not think the experts, if there are any, have a clue, either.
Where do we go from here? We mostly agree that everyone should receive care. And because of concerns about costs, there are encouraging signs on the horizon. Insurance companies and government-sponsored health care programs are designing ways to reimburse physicians and hospitals for quality — not quantity — care. Approaches to payment will change and physicians and patients are becoming more involved in managing costs.
Clearly, we are just at the starting line of a long journey. Rather than turning back the clock, let’s work together as a nation to improve the quality of care for everyone. We spend roughly two times more than any other country on health care per capita. We must ask why we pay more for equipment and drugs than Canadians or Europeans.
When it comes to technology and managing acute or life-threatening diseases, money is no object. But prevention is paid no more than lip service. And unnecessary, duplicative and excessive testing and treatments contribute to the fact that as much as half of all health care costs could be cut by reducing overhead and practicing the right, rather than too much, medicine.
Currently, the only hope lies in insurance companies changing incentives for hospitals and health care providers to practice quality care and cut costs. It is so sad that the bottom line remains the highest priority for the majority involved in health care.
This article was contributed by Dr. David Lipschitz.
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