Apparently I Have An Opinion On Health Care Too!

If you've turned on your TV, glanced at a newspaper, or checked your Facebook in the past 24 hours, you are probably aware of the US Supreme Court ruling on the PPACA (the healthcare reform signed into law back in March 2010). If you're interested in the specifics, you need only google "PPACA" or something of the sort, and you will be inundated with results about what the law entails. In super brief form, it adds several provisions designed to make sure everyone has access to healthcare, as well as means to fund these provisions. One method of funding comes from the "Individual Mandate" (IM), which requires individuals to obtain health insurance or pay a fine/penalty/tax (realistically what it's called doesn't matter because the function is the same in each case). More people buying insurance should increase competition in the market and bring down prices because those that use healthcare infrequently can help subsidize those who use it more often. The Supreme Court case was about this mandate, ultimately deciding it was constitutional under Congress's power to tax. Without the IM, the ACA would face challenges on how to fund the rest of its measures, and that would not be good.

So, why is everyone making so much noise about this law? Good question; one that has many answers. First, people are upset because they feel like they shouldn't be obligated to buy health insurance. Understandable, except for the fact that, at some point, every person will use the healthcare system. This is analogous to car insurance: if you drive a car, you are required (in nearly all states) to have insurance. That way, if someone attempts to occupy your location in space and time, you can be sure to be reimbursed for the energy the imparted into your rear bumper. If you are caught without insurance, you face a fine (sound familiar?). "But Liam," you say, "People who don't drive don't need insurance. I don't get sick, so I shouldn't need health insurance!" Unfortunately, not quite, because by virtue of being born as a human being (welcome to the club, 7 billion strong!), you have entered the healthcare market. You may never get in an accident, but you still must have insurance to cover damages. Similarly, you may never get sick, but you must have insurance to pay for services if you do. Essentially, this is designed to work like Social Security, where the old (sick) are supported by the young (healthy). Everyone becomes old at some point, so it is reasonable to collect money from everyone.

Interestingly enough, people seem to favor the provisions in the ACA, such as eliminating pre-existing conditions, but are against the IM and the law as a whole. This sort of amounts to, "we like the benefits, just not the part where we have to pay for it." While an unpleasant realization, there is no avoiding it. Healthcare is really expensive, and it shows no signs of getting cheaper spontaneously. Resources are limited, and if we don't allocate them responsibly, everyone gets screwed. The real trick is figuring out how to cut costs and manage resources while still getting quality healthcare. Originally, the focus was on waste and inefficiency in administrative and clinical settings. EHRs, streamlined billing, new payment models, and evidenced-based medicine can save money by preventing treatments and procedures that have no benefit as well as minimizing overhead costs. However, new estimates suggest that fixing 'waste' won't make up for the increasing expenditures. This doesn't mean we'll ignore all those savings; we just need to make additional changes. 

Additional cuts will come from limiting some services. We will have to start saying no to some procedures and devices in some patients. Expensive imaging studies or surgical procedures may be foregone in favor of clinical diagnoses and alternative therapies. In addition, the new focus will be on preventing chronic diseases rather than attempting to manage existing ones. For example, look at diabetes and heart disease (co-morbidities in many cases too). Diabetes alone was estimated by the ADA to cost us $174 billion (in 2007). Heart disease (which includes HTN, CAD, CVA, and CHF) was estimated to cost us $272 billion (in 2010). Both diseases are highly preventable with lifestyle modifications and supportive drug therapy if necessary.

I suppose my overall point, and I'm not alone in this, is that healthcare reform is necessary and will occur no matter what goes on in government. I think that having the PPACA and IM is an important step in the right direction, but it is only the beginning. Buckle up, because there's a long, tough road ahead.

Edit
Ran across this article just now. Should help clear up some misconceptions and disinformation.
http://www.usatoday.com/news/politics/story/2012-06-29/fact-check-court-health/55927118/1

Citations

Diabetes stats: http://www.diabetes.org/diabetes-basics/diabetes-statistics/

CVD stats: http://www.theheart.org/article/1176761.do

Bloche MG. Beyond the “R Word”? Medicine's new frugality. N Engl J Med. 2012;366:1951-1953.

Blumenthal D. Performance improvement in health care — Seizing the moment. N Engl J Med. 2012;366:1953-1955.

Brody H. From an ethics of rationing to an ethics of waste avoidance. N Engl J Med. 2012;366:1949-1951.

Fuchs VR. Major trends in the U.S. health economy since 1950. N Engl J Med. 2012;366:973-977.

Song Z, Landon BE. Controlling health care spending — The Massachusetts experiment. N Engl J Med. 2012;366:1560-1561.