I don’t know about you, but I am as anxious about the Supreme Court decision on the Affordable Care Act expected momentarily as I was the first time I turned the car keys over to the 16-year-old. Heck, I’ve been in Jamaica all week on vacation and was still checking the news several times a day.
Why? Because I believe that this decision–whether positive or negative for the law–will send ripples, no, waves, through the economy, the political spectrum, and millions of individual lives.
Our healthcare system is out of control. It is out of control in terms of spending, poor quality and complexity. It is out of control when the major reason for declaring personal bankruptcy in this country is the inability to pay medical bills. It is out of control when, as I read in a recent book by the Medical Director of the American Cancer Society (How We Do Harm: A Doctor Breaks Ranks About Being Sick in America) a woman walks into the emergency room at Grady hospital in Atlanta with her breast wrapped in towels in a bag; the breast that necrosed from lack of blood because the tumor that had been growing there for nine years had cut off its blood supply. Nine years in which this woman knew the tumor was there, felt and watched it growing, covered herself in perfume to hide the smell of the rotting tissue, but never sought care because of a lack of money, fear, and a lack of trust in the system itself. She wasn’t stupid; she was a 50something employed woman without health insurance. Unfortunately, her story is by no means unique.
Will the Affordable Care Act fix all this? Of course not. But it is a step in the right direction. As a major study out of Oregon just found, people who gain insurance, even Medicaid, after being uninsured are healthier, happier, more financially stable, and less likely to use emergency care services than those who remain uninsured. Another story just reported in The New York Times highlights how completely impossible it is for consumers to find out what their care costs because the cost is determined by the power of their insurance company and local medical system.
This is nothing new. I took a course in healthcare economics 25 years ago and still remember the professor warning us that when it came to health care, the basic tenets of the market are missing. Prices are not based on supply and demand; they are not even based on what it costs to make/provide the services, drugs and devices used. They are simply based on what payers will pay. That means if you’re uninsured and don’t have a powerful insurance company negotiating discounts, you are completely screwed. See my blog on this.
Will the Affordable Care Act fix all this? Of course not. But it does enable us to begin testing new payment mechanisms that might—just might—set us in the direction of dismantling the ruinous fee-for-service system that has brought health care costs to the point where they account for nearly 20% of our gross national product.
If the Supreme Court strikes down even the mandatory insurance portion of the Act, it will set us back another 10 years. And after 25 years of covering this system–both the good and the bad—I just don’t think we have the time to start over.
Watch this spot for my post once the SCOTUS decision comes out.