The Great Health Reform Debate

As those of us who are interested in the health reform debate are aware, a majority of the states, and numerous organizations and individual persons, filed actions in federal court challenging the constitutionality of the Patient Protection and Affordable Care Act, signed into law two years ago by President Obama. Two of the four federal appellate courts which have reviewed the issues upheld the law as constitutional; one declared only the so-called “individual mandate” unconstitutional; and, a fourth said the issue is not ripe for decision because taxpayers have not yet paid a penalty. Six hours of oral arguments before the Supreme Court were held March 26-28.  A decision is expected in late June.

I cannot predict the outcome of the decision of the Supreme Court.  What I can predict, however, is that the rate of growth of health care expenditures in the U.S. is unsustainable.  Over 17% of GDP is spent on healthcare and economists predict an annual increase in spending of 10%.

The areas of healthcare which promote this unsustainable growth in health care spending are:  1) unwarranted use; 2) fraud and abuse; 3) administrative inefficiencies; 4) provider inefficiency and errors; 5) lack of care coordination; and, 6) preventable conditions.  The Affordable Care Act was intended to address these issues systematically.

The “individual mandate” was meant to be a shared responsibility requirement to increase the number of individuals participating in the insurance market to make purchasing insurance more affordable for all. While Americans are not now required to buy health insurance, those who do are paying for the healthcare of those that do not. It is estimated that the average American family and their employer pay $1,000 a year extra in health insurance costs to cover care for the uninsured. Many Americans caught up in the media debate and shielded from the true cost of their health care have overlooked the need for health reform.

I can predict, therefore, that persistent medical cost inflation will drive employers to require an increase in employee cost sharing to reduce their health care spend.  While the Affordable Care Act is not perfect (what law is?), health reform is necessary to arrest the amount we spend each year on health care services.  I look forward to the Supreme Court’s decision so we can find ways for providing less costly means of achieving quality outcomes in patient care.