Matthew Breeze
As a primary care doctor, over the last couple of years I have finally been able to help my patients get access to necessary preventive and treatment-oriented care — in ways that were not possible before the Affordable Care Act. The ACA not only increased access to care but allowed the health care system to start making the necessary transition from a focus on treating individuals with disease to a more upstream approach focused on collaborative efforts to maintain the health of our community.
Critics do not acknowledge how fractured and inefficient our health care system was before the ACA was implemented. The hardest hit were working patients not yet old enough to qualify for Medicare but with chronic illnesses and multiple preventive care needs. The upshot was that millions of people simply went without care — diabetes uncontrolled, cancers not prevented, pregnancy care missed, immunizations not given. Deferring care leads to worse health outcomes but also negatively impacts our economy. It is no coincidence that the implementation of the ACA coincided with our emergence from the Great Recession.
The ACA is not perfect. Affordability is still a major problem, as Americans continue to spend significantly more per capita than citizens in any other industrialized nation, with worse health outcomes. But those who opposed a public option for health insurance coverage, or government negotiations for medication costs, now complain about the lack of affordability of care.
Jeff Manning of The Oregonian/OregonLive documents concerns over healthier patients paying more to cover sicker people (“On eve of possible repeal, the good, bad and ugly of Obamacare,” Feb. 4). But this is not new: The system has always depended on cost-shifting. The only real solution is to acknowledge that we are all in this together — until we take a rational approach to managing costs of care, we’ll continue to pay more in the long run.
Even with the ACA, the American health care system is pennywise and pound foolish, as we continue to seek ways to avoid paying up front, leaving us with far greater costs down the road, through inflated premiums, expensive emergency room visits, exorbitant hospital medication costs and paying more for conditions that could have been prevented. Guaranteeing access to quality health care for all would save us all money in the long run.
The ACA was the compromise result of a messy political process — but the alternative is untenable. Within the first days of the Trump presidency, we have seen the chaos that ensues when political ideals take precedence over careful planning and consensus building. The Republicans have painted themselves into a corner by running against the ACA for political reasons without offering an effective alternative. This lack of a clear plan already creats chaos. Since the November election, the health care system has been thrown into a state of uncertainty and fear; patients are anxious about losing benefits; large health care providers are pulling back on longterm plans; insurers are reactively increasing rates. We are already worse off, although no changes have been implemented.
The health care system is extraordinarily complicated, with multiple players and many conflicting agendas, but the ultimate goal needs to be what is best for the health of the patient and our community. Financial gain can be an incentive for innovation, but it also often creates a conflict with the needs of patients. For example, there is less financial incentive for drug makers to develop new antibiotics for short-term use than there is to make medications taken for years for chronic illnesses.
Care for many of our patients is not necessarily a means to profit but rather a duty we have to care for one another. Tom Price’s financial investments call into question the impartiality of his position as a lawmaker and certainly as a prospective Secretary of Health. Careful consensus around the most cost-effective ways to manage our health is the right approach for the health and economic wellbeing of our community. Efforts to repeal the ACA are fueled by shortsighted personal and political gain.
Matthew Breeze, MD practices in North Portland.
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