The patient before me in an exam room was symbolic of the challenges facing the uninsured. She had been diagnosed with cancer after a mammogram detected a mass in her breast; her illness was complicated by the fact that she had no health insurance. By a cruel stroke, her husband had previously been stricken with leukemia and disabled from employment. She was herself unemployed and, with a cancer diagnosis, had no hope of obtaining health insurance.
This story is more common than it should be in the worlds wealthiest nation. As health insurance is largely tied to employment, those with prior illnesses or employers who do not provide insurance benefits are often out of luck. A 2009 Harvard study found that nearly 45,000 people die in the U.S. each year one every 12 minutes largely because they lack health insurance.
As we emerge from a government shutdown sparked by the controversial Affordable Care Act, is there any confidence among the medical community that the law will effectively address the problems facing our health care system? Generally, physicians remain as ambivalent as the public regarding the ACA. Several polls show a majority of physicians have an overall negative view of the legislation. However, there are components of the legislation that strike most physicians as sensible and long overdue.
Access to care: Roughly 48 million Americans remained without health insurance in 2012. The ACA provides several solutions. It allows young adults to stay on their parents insurance plan until age 26. It forbids insurers from denying health insurance to individuals with pre-existing medical conditions. By way of the individual mandate, it requires all Americans to carry health insurance or face a financial penalty. Finally, health care exchanges administered by the states and federal government provide cost assistance to individuals purchasing insurance.
Quality of care: Though the U.S. spends far more on health care than all other industrialized nations, our health outcomes are much worse than countries that spend less. Even prior to the new law, physicians and the health care system recognized this paradox. As a result, movement was already underway within health care to reward physicians for quality of care and improvement in health outcomes. The ACA prescribes less reimbursement for hospitals with high patient re-admission rates or higher-than-average rates of hospital acquired infections. The law also encourages hospitals and physicians to create Affordable Care Organizations to coordinate care for patients. If these ACOs meet quality targets tied to patient health, the parties will receive higher reimbursement rates from Medicare.
Cost of care: According to government statistics, total health care spending in the U.S. is expected to reach $4.8 trillion in 2021, up from $2.6 trillion in 2010. This means that health care spending will account for a staggering 20 percent of the U.S. economy by 2021. While critics point out ways in which the law may cost the system (and taxpayers) more money, the law addresses cost containment in several ways. For example, insurers are required to provide preventative care services for their customers in the hope that such individuals will be less likely to suffer chronic health conditions that could end up costing the system much more down the road.
At the end of the day, what are physicians to make of this polarizing, complex piece of legislation? Is it the death knell for the health care industry or a panacea for all our health care ills? Obviously it is neither but there are still many reasons to be optimistic about the future of American health care.
The ACA has prompted providers to develop creative ways to reward those who provide lower cost, higher quality care for their patients. Broader coverage of preventive services for all Americans gives physicians an opportunity to help keep patients healthier and prevent costly hospital stays. Finally, the controversy surrounding the legislation itself has brought to the forefront a new generation of physicians committed to reforming our convoluted and costly system. No one sees the ACA as a perfect solution, but we should at least view it as a starting point for needed reform.
Charles Williams, M.D., is a family physician in Clayton and co-founder of Project Access of Johnston County, a nonprofit providing free health care to underserved residents.