• The Affordable Care Act

    by Edriss Estime, MD
    on Jan 5th, 2018
The Affordable Care Act (Finally) 

I have been asked on  numerous occasions  what I thought of the ACA, which some are now dubbing the unaffordable care act.

The ACA has been the subject of fervent  criticism and equally ardent praise (maybe not recently). Many have benefited from it. Others have been equally  inconvenienced by it. 
By nature, we like the things that benefit us and we dislike the things that inconvenience us. (Duh!)
Because of the ACA, some were finally able to afford health insurance; but others  have seen their premiums gone  up.  So, naturally some are enthused and others are ticked off.

Admittedly, it feels awkward stating the obvious. But the following may not have been that obvious.

We neglect to look at the larger picture. 

The ACA was benevolent by nature, but utterly miscalculated. Those who praised the ACA years ago are also the same who  demonize it today. That's simply because its outcome was, frankly, unpredictable. To be fair, I must add that the unpredictability  of its outcome was arguably predictable. That is, the Obama administration failed to take into account the human factors and naively underestimated the ever prevailing corporate  greed. 
The ACA's potential success was inherently and profoundly predicated on the cooperation of the major health insurance companies. 
These latter are for profit organizations. They are in the business  of making a lot of profit and one way of accomplishing that end is to avoid paying for the care of people with "pre-existing conditions".  So the question that begs is: Who needs health insurance more than anyone else? Those who are ill (A.K.A. those with pre-existing conditions).  Health insurance companies are, therefore, obviously not  in the business of faithfully  insuring or assuring  the health of those who need health care the most. In fact,  none of the major health insurance carriers can actually claim a net loss as a result of the ACA. Their claim of presumed  loss is only in the relatively small reduction of their projected astronomical profit. A profit that would derive from collecting large premiums and paying very little in health care.
 
I currently have a pile of PA ( prior authorization) forms on my desk for medications that are positively life changing. I'll get to them after missing a few dinners (maybe it's a good thing that it is cold outside now) , but most will be denied again. It's truly a tough conversation when one has to tell a patient: " I know this medication has worked for you very well, but your insurance does not think you really need it. They want you to use one  of those 7 other cheaper ineffective medications  before they would consider paying for what works" In the end, the doctor looks like the bad guy who is not taking the time to fill out and fax the frankly STUPID prior authorization form. 
 
If anything of the points raised  above are arguable, here's what we know for sure and cannot be disputed: 
 
1) Health insurance costs are increasing.
2) Deductibles and copays are increasing.
3) The work load and stress levels of doctors are increasing.
3) Reimbursements to providers are decreasing. 
 
So, my question is : who is getting  (W)healthier from the current healthcare system? 
Author Edriss Estime, MD Medical Director

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