By Bob McCan
How do we create a health care system that: (1) includes everyone, (2) improves everyone’s health, and (3) brings escalating costs under control?
In March, 2010 the President signed the Patient Protection and Affordable Care Act (ACA). This 2,000 page law was crafted to answer those three simple questions.
It passed because our old health care system was broken. Millions could no longer afford insurance as costs rose 8.6 percent annually for twenty years. Employers cut back on benefits. Big business lost competitive advantage globally. Escalating health costs threatened to bankrupt Medicare and indeed the nation. We had little choice but to act. The law was designed to take effect over ten years. After four years, the law is beginning to do its job. It is revolutionizing health care while controlling costs.
Universal Coverage: Based on our deepest value, the sanctity of life, the ACA affirms that every American has an inherent right to health care. This comprehensive plan is leading to universal coverage for 32 million citizens without health insurance. The 2014 enrollment brought almost ten million of these into the system. The 2015 enrollment period, just getting started, promises to enroll several million more. 76 percent of new enrollees, both Democrats and Republicans, are satisfied with their policies.
Improved Health Outcomes: The basics of improved health care are embedded in every policy. For the first time women get treatment that meets their needs. In 2013 hospitals had 1.3 million fewer patient infections and other harmful mistakes than in 2010, with 50,000 fewer patient deaths as a result. The ACA offers financial incentives to both hospitals and doctors for higher quality outcomes. The country is shifting from treatment to prevention, from a sickness model to a wellness system of health care. The Senate just confirmed Vivek Murthy as Surgeon General. He is committed, for example, to dealing with obesity, as required in the ACA, through public awareness, nutrition information on food in restaurants and on grocery packages, along with better school lunches. In the past 50 years similar public awareness programs and new laws reduced smoking from 50 percent of the population to 20 percent. We have also confirmed an amazing truth predicted in the law: As the quality of health care goes up the cost of that care goes down.
Cost control: Rate of growth in health care spending has dropped each year under the ACA. For 2012 and 2013 health care spending rose 3.7 percent and 3.6 percent respectively, and 2014 promises to be the lowest rate of growth in 53 years of keeping records. There are 23 built-in savings, each worth at least a billion dollars annually with combined savings of at least $100 billion annually. As examples, under the ACA insurance companies’ overhead and profits are by law limited to 20 percent for individual policies and 15 percent for large group plans, whereas before the ACA they averaged 25 to 28 percent. State exchanges save money when insurance companies compete against each other in a transparent marketplace. Prior to the ACA physicians, hospitals, medical device makers and drug manufacturers were free to charge whatever the market would bear. Now prices are monitored and price gouging is transparent through comprehensive computer records. In 2010, 1percent of the population spent 21 percent of health money and 14 percent spent 70 percent of the total. The ACA looks at the total system and asks who these people are and why their care is so costly. Most have been found to be mentally or chronically ill persons with uncoordinated care. These ill persons with little money populate expensive emergency rooms. Visiting nurses and health aides are now going into these homes to provide ongoing support and are dramatically reducing the need for expensive hospital care. By August 2013, the hospital readmission rate had dropped by 130,000 as compared to January 2012.
By 2014 four million young adults had obtained insurance on their parents’ policies. Seniors saved $7 billion or $1,000 per person on prescription drugs. Ten thousand persons each month averted financial ruin because their insurance policies could no longer be cancelled after devastating illnesses. Beginning January 1, 2014 every insurance policy offers annual checkups, inoculations, family planning and other basic services at no added cost to the policy holder.
As individuals we want the best coverage at the lowest cost, with ease in signing. We tend to judge the ACA on that basis. As responsible citizens we want good health care for the entire country. We also want policies that encourage good health. Finally, we want reasonable controls over the nation’s spending on health care.
America now has a plan to manage our health care. It is working!
Bob McCan is author of the recently published book “Citizens’ Guide to Health Care Reform, 2nd Edition: The Affordable Care Act Explained and Updated.”