The federal Patient Protection and Affordable Care Act is many things, but affordable is surely not one of them. This choice of adjective would actually be amusing if the true cost impact were not so serious.
Thinking back to the Democratic presidential debates, I remember Hillary Clinton and Barack Obama going back and forth about their intentions to provide affordable health care for all. It sounded good, but of course would be impossible to achieve.
Well, now here we are. As promised, President Obama went after this with zeal despite the many warnings. He was successful in passing the act ”“ all 906 pages of it, with very little clarity, leaving many of us trying to understand what is required.
To be fair, there are some good features to the act, which will be beneficial for many. But at what cost? Definitely not the cost we have been told. Not even remotely close.
Unfortunately, many of the cost drivers of health care were either not addressed or skimmed over ”“ Medical malpractice, medical device manufacturers, pharmaceuticals and excessive waste and fraud, just to name a few. The fact is the cost of health care in the U.S. has been skyrocketing for many years. Naturally we all want the very best care and we are getting it ”“ but can we continue to afford it?
The problem is not, despite what the president likes to state, exorbitant profits being collected by health care insurers. If that were the case, we”™d see many more companies clamoring to get into the market for a piece of the action, as opposed to the number of departures we”™re seeing, leaving us with fewer choices.
Our population is living longer, thanks in great part to the utilization of the high quality health care available. The baby-boomer wave is now starting to overpopulate the health care system. It won”™t be long before the cost of almost all health care plans will qualify for the president”™s “Cadillac” label, which is not a good thing, and practically no plans will qualify to be “grandfathered.”
Although it is a noble desire to make sure care is provided for all citizens of this country, a better strategy would have been to first get the cost of care in line before expanding coverage to all, with no limitations or pre-existing conditions. In fact, there would be many fewer uninsureds to begin with if the cost were more reasonable. Or wouldn”™t it have made more sense to provide perhaps an initial $25,000 to $50,000 of basic care to those who currently have no insurance, to allow the government and industry to brace for what the true impact of this extension of care might ultimately cost?
Also, with most states struggling to get their budgets in line was this the time to saddle them with an expansion of Medicaid beneficiaries ”“ when they cannot figure out how to cover the exploding cost of what they currently have ”“ while at the same time reducing some of their Medicaid federal aid?
And somehow this is all supposed to result in “affordable care”? Not likely.
At the moment, there are legitimate questions as to how much of this act will survive. Aside from the Republicans threatening to defund some of the implementation expense, there is a bigger issue as to the constitutionality of mandating Americans to buy insurance. At first I found this argument confusing, since we are all required to pay into Medicare insurance with every paycheck we receive. There is no opt-out option that I have ever seen. Apparently, the issue is the requirement that the insurance be bought from a private party.
Does that mean the answer will eventually lie in a base government plan similar to Medicare and Medicaid? We shall see.
Rory O”™Brien is the president of The RPO Group, an employee benefits brokerage and advisory firm in White Plains. Reach him at robrien@TheRPOGroup.com.
