American health care is sick. It is a big, complicated, vitally important part of American society – it is woven into our culture, our values, our economy, our communities, our births, our deaths, and our daily lives. It has the enormous charge of keeping us healthy, healing our ills, and easing our transitions into and out of this world. And it isn’t working well for many Americans.
Our government, which plays a central role in our health, tries from time to time to improve our system. The American Health Care Act (AHCA) is the current Congressional effort. It (version 1.0) was developed and seriously considered, only to be pulled from the House of Representatives’ agenda by Speaker Ryan on March 24th. That version has apparently been modified (let’s call it version 2.0), reviving the possibility of legislative action. Unfortunately, this legislative “treatment” will not foster the healing of our system, it will make American health care sicker.
On the face of it, the rationale for the AHCA is to “repeal and replace” the Affordable Care Act (ACA), passed in 2010 under President Obama’s administration. Yet the core components of the ACA are widely supported by public opinion. Even the politically charged label of “Obamacare” has not prevented increasing support for the ACA in response to the possibility of its repeal. So how do we make sense of what’s going on?
It is useful to take another look at what is wrong with our health care system and how that affects Americans – i.e., to get a second opinion on the diagnosis – to understand the cross-currents we are experiencing as a nation.
As Americans we our justly proud of our country, and we are inherently optimistic people, believing in a more prosperous future both for ourselves and our children. This shapes our default view of our health care system – so we understandably note its many accomplishments. Yet the reality is that our system over the past decades has underperformed compared to other countries in the most important areas: our health outcomes are significantly worse across a wide spectrum of conditions and for virtually all age groups, our costs are from 50 to 100 percent higher, and we are distinctive in our inability to provide universal health care. In brief – we currently have a system that produces worse outcomes, costs almost twice as much, and is the most inequitable of any developed country in the world.
These system ills are affecting more and more Americans and threatening the safety-net programs we have in place. Rising costs are arguably the biggest problem. Our country is facing budget shortfalls for vital investments like education and infrastructure, and families are struggling to make ends meet while shouldering more of the costs directly. These issues are rooted in fundamental flaws embedded in our system for decades, not in the recent creation of the ACA.
The ills that Americans want healed via any new “treatments” (i.e., legislation such as the AHCA) are clear:
- An overwhelming complexity that makes seeking and receiving care a daunting experience, itself producing significant anxiety and financial uncertainty for patients and their families
- A fundamental unfairness in which health care insurance is dependent on job status or income
- Costs that claim an increasingly large share of household budgets
- An insurance system that doesn’t protect against unexpected, large financial obligations
These are problems for people with and without health insurance, and at all income levels. Unfortunately the AHCA would not address any of these issues. In fact, it would increase complexity, accentuate inequity, and fail to address the burdens the majority of Americans experience. These costs are largely shouldered by those with employment-based insurance, not those with coverage through the ACA. In short, the AHCA is exactly the wrong medicine for our ailing American health care system.
*This blog is the first post in a three-part series. Part two will discuss how to best treat our sickly health care system.
