Now that the Supreme Court has upheld most of Affordable Care Act under the power of Congress to tax rather than the Commerce Clause of the Constitution, where does health care go from here?
Assuming that the Republicans don’t repeal the ACA in the future, people with pre-existing conditions will be able to get coverage from insurance companies at prices comparable to those who are healthy. This will allow many sick people to obtain medical care that would otherwise not be affordable.
Young people will be able to remain on their parent’s health insurance until age twenty-six which is quite important given the state of the economy and the inability of many individuals to find jobs that provide health coverage, or any jobs at all.
State insurance exchanges will allow individuals to shop for health insurance and find the best plans at the best prices.
People who do not have health insurance will have to purchase coverage or be subject to a tax.
However, with more Americans now having health care coverage, there will not be enough primary care physicians to provide care for them.
And sadly, overall health care costs will continue to escalate as proper measures to control spending have not been included in the ACA. Defensive medicine and unnecessary care must be reduced significantly if costs are to be controlled. According to the Congressional Budget Office, 30% of health care spending currently goes for unnecessary care.
Defensive medicine is the ordering of tests and procedures by physicians to protect themselves against malpractice suits. To end defensive medicine, malpractice reform is needed. However, trial lawyers, who are major contributors to the Democratic Party, are strongly opposed to major changes in the malpractice process. Peer panels to review cases before suits can go forward should be required, with their analysis allowed to be introduced at any trials. Caps on the amounts given to injured patients for pain and suffering should also be legislated.
Even more significant to reducing unnecessary care would be ending the incentives physicians have to perform excessive tests and procedures which increase their income. This means ending the fee-for-service payments that drive unnecessary care with an alternative paradigm. Other methods that could be employed include bundling of payments for particular services, capitation, or having physicians on salary. Over 30% are doctors are already on salary and as I’ve mentioned previously, I favor this course as being the simplest one to implement. It works for the Kaiser system, Cleveland and Mayo Clinics, and there’s no reason why it can’t be successful when applied broadly. Physician salaries could be augmented related to their productivity, patient satisfaction and quality of care.
The Affordable Care Act can be considered as a small step forward in providing universal health care coverage, but without stringent cost controls and without enough primary care physicians to provide access to care. We need simplification of health care coverage, not the greater complexity built into the ACA.
Resurrecting Democracy
A VietNam vet and a Columbia history major who became a medical doctor, Bob Levine has watched the evolution of American politics over the past 40 years with increasing alarm. He knows he’s not alone. Partisan grid-lock, massive cash contributions and even more massive expenditures on lobbyists have undermined real democracy, and there is more than just a whiff of corruption emanating from Washington. If the nation is to overcome lockstep partisanship, restore growth to the economy and bring its debt under control, Levine argues that it will require a strong centrist third party to bring about the necessary reforms. Levine’s previous book, Shock Therapy For the American Health Care System took a realist approach to health care from a physician’s informed point of view; Resurrecting Democracy takes a similar pragmatic approach, putting aside ideology and taking a hard look at facts on the ground. In his latest book, Levine shines a light that cuts through the miasma of party propaganda and reactionary thinking, and reveals a new path for American politics. This post is cross posted from his blog.
Political junkie, Vietnam vet, neurologist- three books on aging and dementia. Book on health care reform in 2009- Shock Therapy for the American Health Care System. Book on the need for a centrist third party- Resurrecting Democracy- A Citizen’s Call for a Centrist Third Party published in 2011. Aging Wisely, published in August 2014 by Rowman and Littlefield. Latest book- The Uninformed Voter published May 2020