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A Prescription for a Healthy Nation

For all the opposition it has generated, the health-care law makes health insurance accessible and affordable and provides consumer protections for patients

Guest Column, Vijay Das

As we consider the President’s remarks at the State of the Union, it is clear that while he is open to work with Republican lawmakers to improve the administration of health care in this country he is committed to protect health care reform.  Health care just won’t go away, but we knew that it would linger as an issue at the beginning of this new Congress.

The Affordable Health Care Act was the President’s signature legislative achievement in the 111^th Congress, and it played a role in the recent midterm elections.  Some even argue that the law’s popular discontent generated by the Tea party faithful resulted in Republicans sweeping most state houses and federal races.  Indeed, almost all of the Democratic lawmakers who voted for the law in competitive races lost their seat.  As we now consider current events, the law remains at a crossroads and often times misunderstood.

This past month Republicans in the House of Representatives voted in lockstep for the law’s repeal, hoping to expose how it hurts private sector employment. Of course while they don’t have the votes to do anything about the law they will be jockeying themselves to underfund most if not all of its provisions in the next two years.

Some have turned to the courts to express their opposition.  The law is being challenged by over 21 state attorney generals and some private groups and individuals.  These groups contend that Congress has no constitutional authority to require almost everyone to hold health insurance starting in 2014 or pay a penalty.  And this is an important provision they are challenging.  As we have seen with some of the early rulings, the results are mixed. The issue is likely to end up in the Supreme Court in the next few years.

The fight is on.  And with a more divided Congress, debates will surface on the purpose behind the law.  Why should we expect anything else? The failed healthcare reform efforts of the early nineties remained in our public consciousness for years. And the healthcare industry makes up over one sixth of the US economy, proving a formidable adversary for anyone to work alongside to reform.

Healthcare reform affects everyone, but will particularly impact Indian Americans, who hold a prominent place in the health care industry. We not only have over 35,000 doctors in America but we also have a large percentage of nurse practitioners, physician assistants, technicians, healthcare administrators, and human resources and benefits directors at large organizations.

As this debate resurfaces, I believe the law is a necessary, pragmatic, and humane way to provide coverage for our healthy and sick.

Firstly, the law has civilized the health insurance industry, making health insurance accessible and affordable to all people who have pre-existing conditions.  It provides consumer protection for patients and expands access to the formerly uninsured, who now comprise over 50 million Americans.  And for those that cannot afford insurance, the law provides tax credits to purchase individual plans.  It attempts to address the market realities for the industry and allow it to grow, expanding the pool of sick and healthy customers. Most importantly, it bans some of the most egregious practices by the industry, including lifetime caps, and allows young people 26 and below to stay on their parent’s medical insurance.  We are fortunate that the law includes many of these provisions, but it is unfortunate that many of them won’t take effect until 2014.

Promoting universal coverage and having insurance companies cover both high cost patients and healthy ones alike is also not simply a more humane and moral thing to do for our sick, but it also allows our system to sustain itself into the future. As long as we all live on this planet, people get sick.  As compassionate people, we know that we need to take care of our sick even if they don’t have insurance.  When everyone is not covered, the first place patients go is our emergency rooms and urgent care clinics.  Many of these individuals do not have insurance and some are even amongst the most sick already who either can’t afford it or have been denied coverage. They eventually get care as the last resort, bypassing primary and preventative health options. This results in ER’s and clinics across America attending to expensive treatment and monitoring options.  These costs are being shared across the board, ultimately hitting all of our wallets with a hidden tax.  

Now, I know that opponents claim the law expands the role of government such that it interferes with the relationship between the doctor and the patient and limits the amount of choices many healthy people can look into for their care. Some further contend that it burdens every taxpayer and discourages firms to hire new workers. 

Contrary to this belief, the law is not a government takeover of healthcare and permits ample plan choices for the consumer.  Yes, the law does tax one if they are not covered, however as I explained earlier, every time uninsured patients receive treatment we all incur a hidden tax.  The law in addition supports the healthcare providers to be more accountable, use cost-effective technology, and not be wasteful.  For instance, it encourages providers to use electronic medical records to maintain their files, ultimately helping providers save millions of dollars annually. 

The law encourages more accountability by our providers, instituting review boards to analyze healthcare data to ensure that care quality is maintained and costs are contained.  And this is very important.  Dr. Atul Gawande, in his most recent New Yorker article, discusses the important introduction of analytical tools and software that can shed light on potential ineffective and costly treatment plans. If we modernize in this field and look at data more effectively, as the new law suggests, we can be more mindful of costs and also reach better treatment decisions that benefit both patients and caregivers. 

The law also incentivizes Americans to be healthier and maintain their health. It actually lifts insurance and overhead burdens for small businesses and will allow these employees to shop for individual and employee group plans most suitable for them.

That said, the law does not completely address the high costs still associated with healthcare. While the reform law certainly expands coverage and holds private insurers more accountable for their actions and premium spikes, health care costs are continuing to soar as we live longer.  Additionally, many point out that the law may encourage insurance exchanges, however it does not provide for a public and truly open marketplace for consumers to freely select from both public and private carriers for their coverage. 

Even with these limitations, the law has changed the way the industry provides coverage for the public, particularly our sick.  Opposition of course remains on the offensive this year and beyond. And to be sure some of the Republican plans we will see will also reflect some of the popular provisions of the new law.  In the meantime, states and municipalities will ultimately be responsible to manage and regulate care, enforcing and implementing the actual law.  Hopefully, Washington and others can give them the green light to do so.

Vijay Das worked on public safety and public health reforms for mayors in Los Angeles and New York City. He served on the World Trade Center Health Panel for the City of New York during 2006-07.