By Arnold Buchman, Senior Advisor to The Margolin Group
Siuslaw News
July 7, 2012
Thoughtful Conservatives and Liberals agree that the Affordable Care Act, while constitutional, is a flawed attempt to remedy our dysfunctional health care system.
Liberals are disappointed in the Supreme Court basing the act’s constitutionality on Congress’ taxing powers rather than its commerce powers. The distinction reverses 70 years of precedents and bodes ill for future Congressional attempts to fashion national solutions to national problems.
Conservatives take long-term procedural comfort in this limitation and see a short-term political advantage of characterizing Obamacare as a tax.
Meanwhile, reported polls continue to show that most people are opposed to the Affordable Care Act even though large majorities favor its constituent parts like extending dependent coverage and eliminating pre-existing condition limitations and life-time caps on benefits. This apparent paradox is probably attributable to a general lack of understanding of what the Affordable Care Act is intended to accomplish and how it would do so. That is of little wonder given the Act’s 2,000-plus pages as explicated by the 193 pages of last week’s Supreme Court opinions to say nothing of two-years worth of speciously glib attacks citing death panels, socialized medicine and the collapse of freedom.
Most people focus on the Act’s intention of providing access to health insurance coverage to the 40 million or so currently without it, not knowing that a major portion of the Act is aimed at making the delivery of health care more efficient, effective and economical. For those now paying ever increasing, debilitating premiums, this has translated into the Affordable Care Act being viewed as an expensive, tax-funded entitlement program. To the extent that the Affordable Care Act guarantees health care to Americans, it is an entitlement program. But, it is one that owes its idea of entitlement, in large part, to an earlier piece of legislation, the Emergency Medical Treatment and Active Labor Act of 1986.
This 1986 legislation was enacted to end a hospital procedure known as “wallet biopsy” that was performed on patients coming into a hospital emergency department. If the patient could not prove they had the resources to pay for care, they could be turned away without treatment or even evaluation, no matter how dire his or her condition. With respect to providing access to coverage, the Affordable Care Act, in effect, can be seen as an extension of the earlier Emergency Medical Treatment Act.
Assuming that most Americans would agree with the public policy goal behind the Emergency Medical Treatment Act, they fail to recognize that they were paying for this policy with a heavy, albeit indirect tax. That tax came in the form of increased premiums by shifting the cost of care from non-paying patients to paying (insured) patients in the form of the $40 aspirin, the $750 stitches, etc. This shift is exacerbated when health care providers attempt to make up for the only-partially compensated costs of patients covered by low-paying public programs (Medicare, Medicaid).
The result has been that as premiums spiral out of the reach of middleclass Americans, there is more uncompensated care to be shifted. As long as we have a medical system model based on employment-status eligibility and fee-for-service medicine, the Affordable Care Act will not solve either the health care funding or delivery problems. Solution lies with replacement of employment-status eligibility with universal coverage and fee-for-service medicine with Geisinger Health System and Mayo Clinic type models of salaried professionals and integrated care.
Until then, the constitutional Affordable Care Act, whether denominated a tax or an exercise of commerce clause authority, is a giant first step in the right direction. Hopefully, Congressional efforts will concentrate on improving it rather than repealing it.
Arnold Buchman
Florence, Oregon