Friday, October 24, 2014
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Lest We Forgot - Obamacare Exists for a Reason

An inaccessible, incomprehensible application website. Health plan options that don't seem to meet the big "A" in "ACA" (affordability) by most Americans' definitions. Longstanding health policies being dropped by insurers, purportedly because plans fail to meet ACA coverage requirements. Shifting schedules for implementation, and vague and ever-changing regulations. Mass confusion. Take your pick, or choose them all; it seems that everyone has at least one legitimate bone to pick with "Obamacare."

Lest We Forgot - Obamacare Exists for a Reason

An inaccessible, incomprehensible application website.  Health plan options that don’t seem to meet the big “A” in “ACA” (affordability) by most Americans’ definitions.  Longstanding health policies being dropped by insurers, purportedly because plans fail to meet ACA coverage requirements.  Shifting schedules for implementation, and vague and ever-changing regulations.  Mass confusion.  Take your pick, or choose them all; it seems that everyone has at least one legitimate bone to pick with “Obamacare.”

What seems to have been lost in the current acrimonious debate is why President Obama chose to go down the “health reform” path in the first place.  So, as we enter a new year, let’s recap: the U.S. healthcare system is mess, and was a mess long before Barack Obama first set his sights on the White House.  Democrats and Republicans all share in the blame for producing and perpetuating a system that overcharges, overtreats some and undertreats others, rewards poor quality, ignores safety, and fails to deliver on any of the Institute of Medicine’s six essential properties: Effectiveness, Efficiency, Timeliness, Patient-Centeredness, Equitability, and Safety. 

I understand the outrage over the ACA implementation disaster.  But, where is the outrage over 400,000 Americans dying every year in hospitals due to infections and other preventable complications of care, or spending twice as much as every other industrialized nation on health care, on a per capita basis, with nothing to show in terms of care access, quality, and health outcomes?  

Most importantly, given the ACA’s core mission of extending health insurance to the previously uninsured, where is the outrage over 40 million Americans not having health insurance?  The United States, despite its wealth, and significant investment in healthcare, representing 18% of the economy, is the only industrial nation that has not had some form of health coverage for all of its citizens.  In my view, that’s more outrageous than any of the potholes we’ve encountered on the road to expanding coverage.

In a seminal report in 2002, Sicker and Poorer, The Consequences of Being Uninsured, the Kaiser Family Foundation reviewed all of the published research available at that time and concluded that the literature “makes a compelling case that health insurance does lead to improved health and better access to care…The uninsured receive less preventive care, are diagnosed at more advanced disease stages, and once diagnosed, tend to receive less therapeutic care (drugs and surgical interventions).”  The lack of health insurance also results in poorer health outcomes, higher mortality, lower work productivity, and less educational attainment.  Nothing published since 2002 refutes these conclusions.

Maybe this is not news, but nonetheless I think it bears repeating as we enter a new year.  Regardless of your feelings about the ACA or the President whose name is permanently affixed to it, I would hope that all or most of us have sufficient humanity to feel outrage and recognize the need for change.


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The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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