I just finished teaching a class at the College of William and Mary on the US healthcare system. Of course it included a session on the Affordable Care Act. But before I could teach about the ACA, I had to teach about our system itself and its problems. After all, how can you understand the need to improve things if you don’t understand the underlying problem in the first place? So here is the Cliff Notes version.
- We spend more per capita than any other industrialized nation and yet are at the bottom on nearly every indicator of quality.(1) As the Institute of Medicine noted: “Much of health spending does little to improve health and. . .may be associated with poorer health outcomes.”
- Since 1945, the rate of healthcare costs in this country has risen so far above the rate of inflation, that if other prices had risen as much a dozen eggs would cost $55. The federal government spends more on health care than on defense.
- Medical errors in this country are so prevalent that they are now the third leading cause of death behind heart disease and cancer.(2)
- We waste $1 billion a year on overtreatment, errors, excessive administrative costs, inefficiencies, fraud, insane pricing, and lack of preventive care.
- Nearly 49 million Americans are uninsured, costing those of us who do have insurance more than $1,000 in what’s called the “hidden health tax.”(3)
And that’s just the tip of the proverbial iceberg.
The ACA is by no means perfect. But its three goals — to reduce spending, improve quality, and increase access, what I call the three-legged stool, is at least a start in the right direction.
I mean, this country has been working on healthcare reform since 1912, when Teddy Roosevelt tried to introduce a one-payer, national healthcare system. If we’d done that, I guarantee (and so do most economists) that we wouldn’t be where we are today.
The ACA has problems. Problems that, if we had a functioning government, could be addressed. We also need more change in our healthcare system than even the ACA provides. But the ACA is a start. It is the law. We have been implementing it for three years–the implementation didn’t just start on October 1.
So before you suggest tossing it like a handful of salt, I think you need to understand it–and understand the problems we’re facing when it comes to healthcare and its impact on the economic health of this country.
If you still don’t like it than answer one question: What do you suggest as an alternative to meet those three goals?
(1) Davis K, et al. Mirror, Mirror on the Wall. 2012 Update. The Commonwealth Fund
(2) James JT. A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care. J Patient Saf. 2013;9(3):122-128
(3) Families USA. Hidden Health Tax: Americans Pay a Premium. May 2009