Saturday, July 25, 2015
The failed promise of the Affordable Care Act
By Trudy Lieberman
It's bad enough that the A.C.A. is fattening up the health-care industry
and hollowing out coverage for the middle class. Even worse, the law is
accelerating what I call the Great Cost Shift, which transfers the
growing price of medical care to patients themselves through high
deductibles, coinsurance (the patient's share of the cost for a specific
service, calculated as a percentage), copayments (a set fee paid for a
specific service), and limited provider networks (which sometimes offer
so little choice that patients end up seeking out-of-network care and
paying on their own). What was once good, comprehensive insurance for a
sizable number of Americans is being reduced to coverage for only the
most serious, and most expensive, of illnesses.
The A.C.A.'s greatest legacy may finally be the fulfillment of a
conservative vision laid out three decades ago, which sought to
transform American health care into a market-driven system. The idea was
to turn patients into shoppers, who would naturally look for the best
deal on care — while shifting much of the cost onto those very consumers.
Comment by Don McCanne
Harper's Magazine has now moved Trudy Lieberman's "Wrong Prescription?"
out from behind the paywall, making it available for free.
It is an extraordinary article that explains the what, why and how we
ended up with the wrong prescription for our sick health care financing
system. Though a fairly long article, reading it and sharing it with
others is an imperative.
The article does not dwell on what is the right prescription, but there
are basically three options:
1. Live with ACA, and try to patch the the defects. The problem with
this is that the fundamental infrastructure cannot be repaired. Patches
are inadequate in that the same basic structural flaws would be perpetuated.
2. Although the Republicans keep telling us that they have a replacement
plan, after five years they have been unable to agree within themselves
on the specifics. That said, they have telegraphed their ideas, and,
combined, they are basically a weaker version of the market-driven
principles already incorporated in the Affordable Care Act. They would
merely weaken oversight of the plans and shift even more responsibility
to the patient-consumer. Being uninsured, underinsurance, and lack of
affordability of adequate coverage would all worsen under their proposals.
3. A single payer national health program - an improved Medicare for all
- would finally achieve our goals of universality, affordability and
accessibility while removing financial barriers through an equitable
system of financing. It is the prescription we desperately need.
Take a moment this weekend to read this article and then share it with
others. At the 50th anniversary of Medicare, this article is very
timely. We have to fix this system once and for all, but that means that
everyone must understand why ACA was the wrong prescription.
at 12:52 PM