Sunday, May 11, 2014

ACA is here to stay

It’s a fair bet to say that the Affordable Care Act is here to stay. Many say that it is an intrusion on their privacy, an abridgement of personal freedom, and maybe even unconstitutional. There is no doubt that the rollout of the federal health exchange was an absolute disaster.

Despite the fear mongering, misinformation, and political posturing, millions of Americans have signed up on the federal and state health insurance exchanges.

So why the optimism? Because things are getting better. As a model for the ACA, the Massachusetts Health Care Exchange has been operating well for several years. Pre-existing conditions and annual and lifetime health insurance limits are gone. Access to Medicaid has been expanded for low income families, federal subsidies are available for many new health insurance subscribers, and new ways of bundling medical costs through accountable care organizations is beginning to take hold.

The Affordable Care Act, or an amended version of it, will transform the American health care system over the long term. The health care system is extremely complex and will require several years to change how doctors are trained and paid, where we receive health care, and how costs for hospitalization, pharmaceuticals, and medical equipment will be reduced. It’s a fair bet that as this transformation proceeds, changes in how the ACA manages health care will be needed.

The health care industry makes up almost $ 2 trillion, about 18% of the US economy. According to several published sources, the annual rate at which health care costs increase at the present time exceeds the annual rate of growth of US Gross Domestic Product, or GDP. That means that every year fewer dollars are available for other important investments like education, job creation, and highways. This crowding out of worthwhile future investment is unsustainable.

Medical industry experts suggest that reducing the annual rate of growth of health care costs to equal the GDP will be a great benefit to the economy. How can this be achieved?

Here are some ideas that have been identified by the experts. Create and standardize an electronic health records system that all stakeholders in the health care industry can use. Just think about it: doctors, nurses, hospitals, pharmacists, and other health care professionals will be able to easily communicate and compare notes about a patient; the cost of filling out and managing mountains of paperwork will be significantly reduced; administrative mistakes and errors in medical reporting will be drastically diminished.

Creating an Independent Payment Advisory Board will identify ways to reduce medical costs under the Medicare program. Promoting accountable care organizations comprised of teams of health care professionals will help increase medical care efficiency by focusing on the health of each individual—sharing lab tests, improving the quality of care, reducing the need for re-hospitalization. If health insurance subscribers can bypass insurance companies at the exchanges and pay directly to accountable care organizations—those who actually dispense health care, then there is a good chance that overhead costs in America’s health care budget can be reduced.

The transformation of the health care industry in America will be a long term effort. If members of Congress can learn to work together, they can make the health care industry less expensive and more efficient. They will have achieved greatness by improving the lives of all Americans.

John F. Zipeto
14 Canterbury Street
Andover, MA 01810