Healthcare reform has dominated much of the political conversation for the past decade—and particularly in recent months when the Trump administration announced its own reform plan to “repeal and replace” the previous administration’s Affordable Care Act (ACA). Both bills have proven controversial, with many different opinions from doctors and patients on the pros and cons of each law.
The ACA, signed into law by President Obama in March 2010, was the product of several years of political maneuvering, industry research, and analysis of different health systems around the world.
Unfortunately, as well intentioned as the law was designed to be, physicians and consumers from various political backgrounds had a bevy of misgivings about several of the law’s primary adjustments to the U.S. healthcare system. Major reform areas included enforced universal insurance, a push towards updating industry technology, and significant changes to the payment structures and measurable outcomes in order to lower overall healthcare spending.
Physician opinion, in particular, varied greatly, and there are still debates underway about the best path to achieving successful healthcare reform.
The newest administration’s efforts included several plans to completely scrap the ACA and reduce overall federal funding to several healthcare programs, including Medicaid, in order to reduce overall government spending. Their most recent bill, the American Health Care Act (AHCA) of 2017, successfully passed the House in May 2017, though it is still pending Senate approval. The law would effectively eliminate mandatory health insurance and undo many of the expensive protections that required insurers to provide coverage without consideration for pre-existing conditions.
For some physicians, this stepping back of the federal government’s involvement in the healthcare industry is a boon.
According to R. Lynn Wilson, a retired hospital executive with nearly 40 years of experience in the industry, “The real issue is that all Americans with or without health care insurance need affordable access to the delivery system. Hospitals are required by law to provide care to patients regardless of their ability to pay and routinely charge according to ability to pay for patients without adequate insurance.”
Wilson goes on to explain that the cost associated with keeping everyone insured actually takes away from many hospitals’ abilities to provide quality care. The ACA system, from his viewpoint, caused many doctors to be overworked and underpaid, while patients often had to experience significant wait times to see specialists or do without certain services altogether. Updating equipment and facilities was also extremely difficult, since there wasn’t sufficient funds to reserve for those purposes under the ACA.
“Americans wouldn’t tolerate this and this is where Obamacare is taking us,” said Wilson. “Obamacare is a ruse. It is a Trojan horse designed by progressive Americans and progressive politicians to push America into socialized medicine.”
Of course, Wilson’s opinion is just one side of the coin. Other physicians and hospital administrators take a completely different view on the topic.
According to a Nathan Markowitz, a gastroenterologist and contributor to The Oregonian, the key to healthcare reform is not “repeal and replace” but “repair”.
“The Affordable Care Act, as written, is fraught with problems,” wrote Markowitz in January 2017. “Nonetheless, 22 million previously uncovered Americans now have health insurance, and the overall uninsured rate is the lowest in American history. Most big policy changes require major rewrites: ACA is no different.”
Markowitz represents the physician opinion that the goals of the ACA were not bad, just a bit overwhelming for time. He recommends an adjustment in focus—but one that would keep the option for national healthcare and universal insurance in place. Support for malpractice reform, adjustments to HIPAA and health technology laws to make implantation more practical, and a thorough re-examination of the insurance mandate are all adjustments that, according to Markowitz, could turn the ACA into a viable and supportive law resulting in improved healthcare across the U.S.
Finally, there are those physicians who can see both sides and want to find a middle ground.
According to a recent Forbes article that was contributed by Louis J. Goodman, Ph.D, CAE, and board member of the Physicians Foundation, as well as an executive vice president and CEO for the Texas Medical Association (TMA), both bills have similar premises and the best path might be finding a solution that supports those key goals.
To Goodman, both bills are built around the goal of reducing overall healthcare costs. The big difference is that while the ACA was heavily weighted towards improving access to healthcare coverage, the AHCA was designed to promote improved choices and lower taxes.
“I believe both parties can find common ground in the two bills’ common aim to reduce costs and their rate of increase,” stated Goodman. He proposed starting with “the two fastest growing components of our national health expenditures: expenses for administration and drug prices.”
No matter what side of the debate you fall on, Goodman makes a compelling argument that the issue has been divided between laws and parties when the reality is that the issues are sometimes more complex than the laws are addressing.
The only certainty is that more changes are coming.