Obamacare website glitches have distracted the country from the purpose of Obamacare in the first place.
The Affordable Care Act was created to make medical care more affordable. It was meant to "...expand access to affordable quality health care to tens of millions of uninsured."
In the 1930s at the inception of FDR's "New Deal" programs, "health management organizations" were created to consolidate health care under corporate entities that could cut costs.
By the early 1990s First Ladywas bandying about "Hillarycare"---the idea of a mandate for corporations to provide health insurance coverage through HMOs. That measure was defeated by heated conservative resistance in 1993. But the problem of health care spending did not go away.
The Health Care Cost Institute says, "The United States has a profound problem with health care spending." Yet according to both the B.E. Smith survey of 2012 and the Health Administration Degrees directory of 2013---Medicare and Medicaid reimbursement for health care organizations is actually decreasing. Compliance risks and operational costs are shifting to the health care providers.
The HCAHPS national patient satisfation survey is an instrument of the new pay-for-performance measures that determine how much federal reimbursement an organization can receive. Both B.E. Smith and the Health Administration directory predict that Congress is liable to cut as much as 20 percent of Medicaid and Medicare funding for reimbursement expenses this year.
Health Administration Degrees' directory elaborates that the medical industry is crippled by the soaring costs of prescription drugs. The overall cost of prescription drugs increased a deceptively low 3.7 percent last year: merely .3 percent for "generic" drugs and a whopping 9 percent for anything "brand-name." Worse, ACA is partially paid for by the taxation of pharmaceutical companies---an "operational cost" that will blow back on the consumer, not government.
In a Forbes article published May, 2012, John Lechleiter writes that "clinical trials can take many years and involve tens of thousands of patients." This is necessary in an industry that affects so many people so seriously. These trials are no guarantee that a drug candidate will get off the ground---it has to endure FDA approval. So a product launched today might be available by 2022. By the end of testing a company will have "spent at least a billion dollars and a decade or more." There's no "silver bullet" to incline them to charitability, and a $259 billion dollar business to entice them. Figure 5 of the images to this article shows that according to Henry J. Kaiser Family Foundation (KFF) prescription drug costs consume 10 percent of national health expenditures as of 2010.
The real problem for the medical industry today is the premise of Lechleiter's article. This problem of medicine is a problem of its success.
Life expectancy in the United States has increased by 67 percent since 1900, from 47 to 80 years of age. Death due to heart disease has plummeted by another 67 percent since the 1960s. HIV/AIDs deaths have declined by 70 percent from the mid-1990s.
The medical industry is getting more expensive because there's more people being taken care of by the medical industry. It's so simple that it's not.
It's one of the few trends that the entire health care community achieves consensus on. The Smith survey deduces longer lifespans mean an increase in chronic conditions, obesity and poverty. The new Medicare 30-day return stay rule drives health systems to partner with long-term providers to improve patient care. In fact the biggest challenge for the new "accountability care organizations" being coordinated under Medicaid will be "population care management." This means promoting a campaign of preventive medicine while they "manage their chronic conditions" says Cognizant.com. Figure 4 in images from KFF shows that patients 65+ years of age are costing almost four times what 25-44 year olds incur in health expenditures.
It makes sense then, that according to Figure 1 of the KFF presentation, expenditures on health have risen from 5.2 percent per capita in 1960 to 17.9 percent in 2010. Figure 2 shows that growth rate in expenditures has outpaced the growth in GDP by an average 2 percent annually over the same time. Figure 3 shows that American health care is actually more costly, and less cost-effective than most European countries with more socialized systems. Perhaps worse, Figure 5 reflects that right now our greatest costs are hospital and clinical care---it doesn't even take into account a rising tide of long-term care costs that will only get worse with a couple decades' time.
Figure 6 of the KFF presentation demonstrates that health insurance will mitigate most of the cost of hospital care, clinical services and prescription drugs. But even in 2010, the cost of long-term care for the elderly was mostly out of pocket. Figure 7 attests what we would historically suspect---that health care expenditures covered by private insurance have largely leveled off since the 1990s. Medicare and Medicaid have been "picking up the slack" long before the enactment of Obamacare. Lastly, Figure 8 represents the exponential increase in out-of-pocket expense that is concealed by the decreasing proportion of out-of-pocket costs.
So how did the growth rate of national health expenditures slow down somewhat in the past decade? Pricewaterhouse Coopers explains the phenomenon best:
Seventeen percent of employers in PwC's 2013 Touchstone survey today offer a high deductible health plan as the only option for employees...When consumers pay more for their health care, they often make more cost-conscious choices.
Obamacare, as we know through common knowledge regarding "Bronze Plans," is merely designed to get health insurance to more people who couldn't afford it. It is powerless to stop this trend. We agreed on Obamacare in the first place only because it was "better than no health care at all."
Which is true. Obamacare is a good thing in that it addresses what we recognize to be a serious issue in the medical industry. Unfortunately it does little to reform the medical industry writ large.
The way I see it, we are presented with two choices: We can look at health care as a "right" or "entitlement" like Social Security over which all parties can dig in their heels...and we can keep doing what we're doing. Or, we can look at the medical industry as simply the essential service that it is: merely improving quality of life while making it affordable as possible.
We can tax pharmaceutical companies to bankroll our "right to health care" and add to their operating costs that mark up retail prescriptions. We can pat ourselves on the back for legislation that has transformed the HMO into an organization that bears all financial risk and responsibility so that we could take it off the backs of patients. So long as we understand that those higher risks translate into higher operating costs, higher hospital bills and finally spill onto our insurance premiums.
The "pay-for-performance" that we enacted with "accountable care" now means reduced Medicare/Medicaid reimbursement...private providers will retaliate by dumping uninsured patients. Compound that with a "talent gap" that B.E. Smith says leaves us 63,000 physicians short by 2017, and we can recognize that we have not begun to address the problem.
Lastly, we can preserve our "semi-private" archaic health care system for the sole purpose of disseminating every medical procedure and prescription drug available without real regard for cost or benefit. With all the money we throw at it, we could very well create a future, dystopic society where we can all live to 100---we just won't have the bank accounts left to enjoy the years.
We are nowhere near solving this problem of medicine.
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