I have been simply amazed by some of the reactions to the recent Supreme Court decision on the Affordable Care Act.
As a practicing orthopedic surgeon in rural Maine, and as president of the Maine Medical Association, I observe every day the holes in what we loosely call our nation’s health care system. But it is not a system. Rather, it is a patchwork of thousands of physicians, nurses and other health professionals, hospitals, health insurance companies, the federal and state governments, the pharmaceutical industry, device manufacturers and finally, patients. It is a hybrid, relying on for-
profit and nonprofit companies, public sources of funding including Medicare and
Medicaid, and a large portion of private funding. What the Affordable Care Act does not do is change the fundamental structure of this nonsystem.
So when I read reactions decrying a “massive government takeover” of “health care,” I want to laugh until I realize that these critics of the decision may actually want to take Mainers back a half-century to the 1950s when we relied almost wholly on employer-paid health insurance, charity and other private sources to finance health care. While it may be nostalgic to look back to a simpler time before Medicare and Medicaid, before the Internet and before joint replacements, cardiac bypass procedures and renal dialysis, medicine has advanced dramatically since then and so have the lives of our patients. The establishment of Medicare nearly 50 years ago has been the most positive social change for our elderly population since the enactment of Social Security. Medicaid benefits our most disadvantaged citizens and tens of thousands of children whose family’s earnings are below the federal poverty level.
While neither the current system nor the ACA is perfect, the law does have direct benefits to patients and continues to move the nation forward toward the ultimate goal of every citizen having access to affordable, high-quality health care.
Foremost among these benefits is the coverage, without cost sharing, of preventive benefits such as well-baby visits, vaccines and screenings for cancer, diabetes and depression. The opposite of a cut to Medicare, it adds a new Medicare wellness visit and improves the Medicare Part D prescription drug benefit to help seniors afford livesaving medications.
Other notable ACA benefits include the creation of “exchanges” (coming in 2014) to assist consumers with shopping for affordable private health insurance coverage and subsidies to support the purchase of health insurance for those families earning under 400 percent of the federal poverty level. This last point has been overlooked in much of the rhetoric and media attention. While most Americans will have to buy health insurance or pay a penalty (we can say “tax” now that the court has ruled), almost all of these people will receive generous help paying for these plans. And with the creation of the exchange and the funding of a new consumer-owned and operated plan in Maine, these products hopefully will be more generous in what they cover and at lower cost.
I also have heard the myth that health care reform will force patients to change doctors or will “come between” the patient and the doctor. The ACA actually contains several new protections that give people with private insurance the guaranteed right to choose their own primary care doctor or pediatrician. And all of your health care decisions will continue to be made between you and your doctor. The government will not get in the way of this special relationship.
The ACA is, in fact, a very conservative law in many aspects, in that it builds upon the existing private/public system. If the Congress wanted to “take over” health care in our nation, there are plenty of models around the world that it could have chosen from, including from our neighbors to the north.
Here in the U.S. we are left with incremental reform. It isn’t pretty, but let’s keep the ball moving as we work to implement the law and provide health insurance, some private, some public, to 30 million Americans who are uninsured, including approximately 130,000 of our friends and neighbors right here in Maine.
Dr. Nancy M. Cummings practices orthopedic surgery in Farmington and serves as president of the Maine Medical Association.