Why are we so divided?

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


8 Responses to “Why are we so divided?”

  1. Margaret Groves

    How exactly is the ACA supposed to reduce the insane costs of health care and stop unnecessary procedures? All I can see is hard-working, healthy people being penalized with higher “insurance” premiums while people who choose unhealthy behaviors like smoking and getting overweight are not penalized at all. I would support a system where people can get reduced premiums for not having an unhealthy lifestyle.

    • Debra Gordon

      Hi. Thanks for your comment. Higher insurance premiums are based on so many factors beyond the personal habits of individuals, primarily the cost of medical services themselves (why does a $1.00 bag of saline get billed at $500? See NYT article on this). Many employers DO offer lower premiums for having a healthier lifestyle, and the plans on the ACA exchanges have lower premiums for people who do not smoke.

  2. Jim Stroo

    Good points! But a chicken was a chicken in 1945 and it is still a chicken today. Same for the eggs. Healthcare in 1945 is does resemble the healthcare of today from technology, pharmacueticals, to defensive medicine.

  3. donaldstumpp

    Exactly! What do you suggest as alternative? Unfortunately a point missed by the opponents of ACA.
    The US has chosen employer-based healthcare – that could be the first alternative is to eliminate that – but it is so ingrained in the US, a radical change would not be possible. So with employer based healthcare, employers need to equally share. It is not right for IBM or Big Corp to pay the healthcare costs of the employee of Papa John’s or Little Co because they dont give their employees healthcare. They do because Big Corp gives dependent coverage.

    But to the question Why are we divided – I’m sorry to say it is because of blatant mistruths (death panels) and perpetual grandstanding (‘healthcare disaster’ “government controlling your healthcare”) put on by the Republicans for political reasons.

    • Debra Gordon

      I completely agree with you. If only people would stop basing their opinions on anecdotes and consider actual factual evidence from unbiased experts such as the Kaiser Family Foundation, the Congressional Budget Office, and other healthcare experts.

  4. Jun

    The irony is that the content in the ACA was what Republicans and their backers came up as an alternative to the Hillary Clinton version of health care reform, which would have been a lot more useful and effective. Now the conservative machines are doing everything they can to tear down what they had initially proposed years ago. It’s perfect evidence that they don’t really care what is actually in ACA. The real target of their hatred is not ACA.

    • Debra Gordon

      I try to stay out of politics, but I agree with you. We need to focus on the facts, not the anecdotes.


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