The recent high stakes drama in Washington about the repeal and replacement of the Affordable Care Act has sparked much soul-searching among physicians about the importance of quality health care.
Healthcare is intensely personal, and how we feel is defined by our energy, strength and sense of well-being. When we are healthy, life is good, but when we don’t feel well or suffer with the effects of a chronic illness, life is a daily struggle. Over the 30 years I’ve been practicing medicine, the world around us has changed dramatically: how we live, how we communicate, the technology we use and the availability of information has evolved exponentially.
But many things remain the same. Patients want comfort, security and peace of mind, and freedom from pain, uncertainty and disability. It is a physician’s privilege to work with patients and help them achieve these goals. In fact, the doctor/patient relationship is the foundation of quality healthcare.
But there is more to it than that. The Institute of Medicine defines six attributes to quality health care:
• Do no harm;
• Provide care based on individual needs;
• Minimize delays and wait times;
• Provide evidence-based treatment;
• Give patients value for their money;
• And deliver the same level of quality care for all.
As a family physician, I was trained to have the broadest view of the landscape to treat my patients. That means considering all the elements that contribute to my patient’s diagnosis and to their overall health, including their cultural and ethnic backgrounds, diets, occupations, economic status and lifestyle.
These aspects of our social fabric define our lives and, to a great extent, determine our health. This is especially true for the vulnerable members of our society: the working poor, those suffering with mental illness, the frail elderly, the disabled, racial and ethnic minorities, and the homeless. Their health and healthcare problems intersect with housing, poverty and inadequate education.
Since the implementation of the Affordable Care Act (ACA/Obamacare), over 20 million more Americans have been able to purchase or qualify for basic health insurance. Every day in my office I care for patients on Medicaid, on ACA-created healthcare-exchange insurance, on Medicare, Medicare Advantage, and on traditional employer-based health insurance, and I am able to see and treat them all.
All of these patients receive “essential health benefits” as defined by the National Academy of Sciences. They all receive 100% coverage for preventive care, and I can work with all of them to make sure that, together, we design a plan to get them the care they need at the best value possible.
Technology in medical practices now allows for unprecedented accountability, both from the clinician and the patient. My family medicine practice reaches out to those who should get help but don’t: the diabetic patients unseen for months; the depressed patients who don’t regularly refill their medications;the elderly who are increasingly at risk of neglecting their health and their safety but are too proud and/or unable to meet their own needs. With any attempt to dismantle the essential umbrella of necessary primary healthcare, these efforts will degrade and disappear. That cannot be allowed to happen. All of my patients now have the opportunity to build a therapeutic relationship with me and with the specialists to whom I refer them.
The Kaiser Family Foundation conducted a health tracking poll in December 2016 that found an overwhelming number of people were in favor of retaining certain provisions in the ACA:
• 85% favor keeping young adults on their parents’ plan until age 26;
• 83% favor eliminating out-of-pocket costs for preventive services;
• 80% support providing the states options to expand Medicaid to cover low-income/uninsured patients;
• 80% favor financial help to low-income Americans whose employers do not provide health insurance;
• 70% support prohibiting insurance companies from denying coverage for pre-existing conditions.
We need the Affordable Care Act (ACA) “2.0.”
Strengthen the healthcare exchanges. Do what is necessary to incentivize young healthy adults “the invincibles” to buy the insurance product that they need.
Get everyone eligible for Medicaid covered if we want to keep the rate of the uninsured at the historically low level it is at today.
-continue to introduce new payment models that emphasize the clinical outcome for the patient and the importance of delivering high-value healthcare. The fee-for-service model must give way to these changes.
Don’t throw the baby out with the bathwater, fix what needs to be fixed and do the hard work to build a better Affordable Care Act as was done with Medicare over 50 years ago.
The GOP’s American Health Care Act replacement to the ACA,which rolled back coverage for “essential health benefits” and preventive care, put the nation’s health at risk.
As an example, look at what the ACA did for people with cancer, an intensely personal illness. In the first three years, the ACA’s coverage for cancer screenings increased the diagnosis of early-stage colon cancer among Medicare patients by 8%. Lives were saved by early detection coverage. No American should have to choose between cancer screening and living expenses. Mental-health care is also an “essential health benefit.” When untreated, depression, bipolar disorder, schizophrenia, and other mental illnesses lead to higher rates of suicide and isolated and tragic episodes of gun violence.
Fiscally, the Congressional Budget Office estimates that a repeal of the ACA would increase the number of uninsured by 24 million thru 2026, and I am certain that any dollars saved through reduced premium for bare-bones catastrophic-only health insurance and through the inability of older Americans most in need to purchase health insurance would be offset 10 times over by an increase in sickness and illness requiring much greater healthcare expenditures over time.
We will be striking a blow to the heart of America‘s health and well-being if we return to an era of isolating our most vulnerable individuals from needed healthcare. We can’t go back to a time when preventive care is nonexistent and overcrowded emergency rooms are our defacto primary-care providers. We must move toward – and not away from — the “triple aim” of improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care.
Good health care is an investment in the future of our country.
H. Andrew Selinger MD is Chairman of the Department of Family Medicine at the Frank H. Netter MD School of Medicine, Quinnipiac University.