More Money to be Made On Sickness than Health: Why Reform Isn't Working

More Money to be Made On Sickness than Health: Why Reform Isn't Working

The Affordable Care Act was sold to Americans as a way to overhaul healthcare. Many enticing promises were made to garner support. Politicians and pundits have both been selling the benefits of the law without understanding the difference between health insurance reform versus healthcare reform. 

It is true that the healthcare system is broken. Costs have risen to unacceptable levels. However, it is not because of doctors. The truth is because of a progressive decrease in reimbursements over the last 10-15 years doctors have become increasingly less of a factor. The true costs are driven by hospitals, the pharmaceutical industry, government regulations requiring compliance, and indirectly the food industry which is an important underlying factor in the explosion in the rise of chronic diseases such as obesity and diabetes. Unfortunately, Obamacare will do nothing to change these problems. In fact it has doubled down on the root cause of rising healthcare costs by giving more power to health insurance companies.

If the architects of ACA had bothered to ask practicing physicians what they thought, they would have been told that the fatal flaw of Obamacare was the belief that having health insurance equals having good healthcare. It is illogical to believe this when you consider that in order for a health insurance company to make a profit it has to take in as much money in premiums as possible while paying out as few claims as possible. The salaries of the CEOs of the various insurance companies suggest that the industry is doing an excellent job, and the way the bill was crafted it guarantees that the status quo will remain.

Despite all of the rhetoric of how wonderful Obamacare is, the fact is to date the bill has had the opposite effect:

  1. Instead of slowing and subsequently decreasing healthcare costs, in the two years since ACA was passed healthcare costs continue to rise in part due to the specific tenants of the bill. It is hard to argue that the bill was really designed to decrease costs when key tenants such as the inability to use the health savings account to buy over the counter medication or the possibility for patients to access cheaper drugs from outside the US exist.
  2. There has been acceleration in the consolidation of hospitals into larger systems at the cost of smaller community hospitals and independent outpatient surgery centers removing patient access to lower cost alternatives. Furthermore, the flow of money to hospitals tied to increasing government compliance mandates without requiring cost controls and pricing transparency have guaranteed continued astronomical healthcare costs (e.g., in some cases with hospital costs that are in some cases ten times more than what it costs to receive services in an outpatient facility such as a surgery center or independent radiology facility).
  3.  The individual mandate, the most egregious portion of the bill, is for all intents and purposes a tax, and it will force Americans to support an insurance industry that routinely rations care by limiting access to care in the form of high deductibles, co-payments, pre-certifications, treatment restrictions (i.e., evidence based medicine), and outright denials. There was neither an attempt to reign in the abuse of patients by shifting costs and denying care to patients, nor to stop the interference with the doctors’ ability to practice sound medicine by providing the treatments that they and their patients deemed necessary.
  4. Access to doctors has decreased due to the flight of independent doctors from private practice into employed positions in large groups and hospitals, thereby moving patients into clinic settings with longer waiting time for appointments.
  5. The reliance on ‘best practices’ and evidence based medicine has lowered the standard of medicine by making it one size fits all. It has taken the power of healthcare away from the doctor and the patient and given it to the pharmaceutical industry. This has had the chilling effect of increasing healthcare costs while making the healthcare system one that is based on the management of chronic disease instead of wellness – a system that is inherently more expensive.
  6. Although you cannot be denied for having a pre-existing condition you can still be denied if the insurance company finds that you have lied on your application (even an inadvertent mistake can be considered a lie). More likely, an individual with a pre-existing condition may be priced out because of a high premium and/or deductible.

True healthcare reform means limiting the power of insurance companies not expanding it. Over the last two years insurance companies have actually made record profits because people have accessed their healthcare insurance less – having out of pocket expenses up to 10,000 for an individual policy in addition to paying a premium will do that. The truth is although it makes a great rallying point, nothing is for free. The implementation of Obamacare will cost patients more and they will receive less care. In short, the bill serves to further the very corporate interests (i.e., the insurance industry, the pharmaceutical industry, hospitals and the American Medical Association) that have inserted themselves between the doctor and the patient while raising healthcare costs. Instead of stopping this, ACA rewards them because there is more money to be made on sickness than on health.


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