What now for Obamacare?

By Robert Gillette

Special to the Vindicator

Vindicator readers who are concerned about the future of health care in America should dig the “A” section of June 29’s edition out of their recycling bin, or bring it up online, and reread and ponder the extensive coverage of the recent Supreme Court battle over the Affordable Care Act (also called Obamacare). The court gave President Obama’s legislative plan a (mostly) green light, but its verdict left health care politics more muddled and bewildering than before.

Let’s revisit some of the hard facts. We in the U. S. pour one-sixth of all dollars spent in our nation each year into medical services, far more per capita than any other industrialized nation. Yet compared to the others, we’re in the middle of the pack on life expectancy and infant mortality, embarrassingly poor on the number of citizens lacking health care cost coverage, and shameful in terms of families foreclosed out of their homes by overwhelming medical bills. America doesn’t have the best medical care in the world — just the most expensive.

This problem has been recognized for more than a half century, but previous efforts by U. S. presidents to solve it have all failed. The causes for this have included political tension between liberals and conservatives, the reluctance of physicians to give up their professional autonomy, political maneuvering by sellers of medical goods and services, and the fact that health care is inherently complicated and difficult to explain to voters. The cost of medical technology keeps rising. Our population keeps getting older and we have increasing numbers of seniors with multiple health care needs that are costly to treat.

Honest differences

Judging the merits of a refrigerator or automobile is relatively simple, but assessing the quality and cost-effectiveness of a physician, a hospital or a surgical technique is harder. There can be honest differences among doctors as to whether a particular patient is sick enough to need a certain procedure. New diagnostic or treatment methods are often adopted before their value has been proved. Families are understandably upset when one of their members is ill, and it’s not surprising that their desire for “the best” sometimes leads them to pressure the physicians to order procedures that are unlikely to help. And, yes, complexity sometimes gets in the way of clear thinking, leading doctors to follow the path of least resistance. The situation will continue to deteriorate unless major change is achieved soon.

So where do we go from here? The path is clear: smooth off some of Obamacare’s rough edges and make it work, with or without Republican help. The law isn’t perfect, but it’s the best that could be achieved in today’s poisonous Washington atmosphere, and it has enough cost control features to reduce the rate at which medical expenditures are increasing.

The president has held the door open for Republicans to join him in improving the ACA, but they are too firmly wedded to their goal of destroying Obama politically to co-operate. That’s a real pity for the nation. We have pretty good new legislation that could become excellent if the two parties could stop throwing dead cats at one another and do what is right for the American people.

There is reason for optimism on another front. This writer, although retired from patient care, follows a medical internet site. There has been a recent upsurge in reports of medical research focused on reducing costs by discontinuing the use of methods that have been found ineffective. Doctors and medical systems seem to be getting the message about reducing waste without cutting quality. Hallelujah!

Gov. Romney’s announced plan to kill the ACA and replace it with a “consumer market” is absurd. Our present mess is, in large part, the result of assuming that a marketplace approach to funding healthcare can work. The “product” is too complicated, too unpredictable for individuals, too opaque in its functioning for that.

Robert Gillette is a retired physician who lives in Poland.