MSV speaker: Affordable Care Act is a step in right direction
Posted: October 3, 2012
The Winchester Star
WINCHESTER — The 2010 Affordable Care Act may not be perfect, but it is a step in the right direction to fix a mangled health care system.
That message was delivered in great detail to more than 300 in attendance Tuesday afternoon at the Museum of the Shenandoah Valley Business Forum Luncheon.
Susan Dentzer, editor in chief of the journal Health Affairs, broke down just how broken the American system is: poor health, low-quality care and high costs.
The Affordable Care Act (ACA) is working to fix those problems — and has already made progress in some areas — but Dentzer cautioned against judging results too quickly.
Solutions won’t come easily or quickly because what’s needed is a complete reprogramming of the way the country’s health care system is wired, she said.
According to Dentzer, the ACA is attempting to reverse a core problem of the U.S. system: fee-for-service payment.
“If a doctor does something to you, he gets paid for it,” Dentzer said. “If he doesn’t do something to you, he doesn’t get paid. What do you think the incentive is as a consequence of that?”
To answer her own question, she quoted Irish playwright George Bernard Shaw, who said, “That any sane nation [should] give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair.”
Payments should be based on health outcomes, Dentzer said.
The ACA has multiple provisions to encourage such a transition, including one that went into effect Monday to reduce unnecessary readmissions to hospitals.
Medicare, using its financial muscle, started penalizing hospitals for readmissions within 30 days of discharge.
The threat of decreased Medicare reimbursements is an incentive to hospitals to make efforts to ensure there is fluid care once a patient is discharged.
The ACA has also addressed and will continue to address the problem of the uninsured — 18,000 of whom die prematurely each year from not having health insurance, according to an estimate from the Institute of Medicine.
“That’s about half as many women [in the U.S.] who die from breast cancer each year,” Dentzer said.
The uninsured also drive up costs for everyone else, since they’re usually less healthy and end up in the emergency room when they become seriously ill.
But because of the ACA, the number of uninsured is decreasing — largely because of a provision that has already gone into effect allowing young adults to remain on their parents’ plans until age of 26.
In Virginia alone, 41,000 young adults are still on one of their parents’ plans.
The next step is for Virginia to put in place an insurance exchange — which will be an online marketplace for insurance shopping — and the expansion of Medicaid to cover more uninsured individuals.
Gov. Bob McDonnell has remained noncommittal on both fronts, citing cost concerns.
Vicki McClelland, executive director of the Free Medical Clinic of the Northern Shenandoah Valley, said she’s keeping her fingers crossed the state will set up exchanges and expand Medicaid because “it will help so many Virginians.”
Dentzer, while noting that the ACA isn’t perfect, is hoping that everyone will turn their focus toward innovation.
“We could really have a health care system in this country rather than ‘sick care,’” she said.
— Contact Conor Gallagher at cgallagher@winchesterstar.com