What is the Future of Affordable Health Care? Where is the Great Society?


As the Affordable Care Act (ACA) matures it is interesting to try to predict the sustainability of the program. I thought that I would try to look at the Massachusetts health care program, the model for the ACA. The landmark 2006 Massachusetts health-care law, also known as Romney Care that inspired the federal overhaul didn’t lead to a reduction in unnecessary and costly hospitalizations, and it didn’t make the health-care system fairer for minority groups, according to a new study that may hold warnings for the Affordable Care Act.

Massachusetts’ uninsured rate was cut by half to 6 percent in the years immediately following the health-care law signed by then-Gov. Mitt Romney. Blacks and Hispanics, who have a harder time accessing necessary medical care, experienced the largest gains in insurance coverage under the Massachusetts law, though they still were more likely to be uninsured than whites.

The new study, published in the BMJ policy journal, examined the rates of hospitalizations for 12 medical conditions that health-care researchers say wouldn’t normally require hospitalization if a patient has good access to primary care. These include hospitalizations for minor conditions like a urinary tract infection, or chronic conditions that would require repeat primary care visits over the course of a year.

“It’s thought to be a good measure and one of the few objective ways of looking at access [to health-care provider] in the community,” said Danny McCormick of Harvard Medical School, the study’s lead author.

McCormick, along with Boston University School of Medicine researchers, looked at every single such hospital admission in Massachusetts in almost two years before and after the state’s health-care law was enacted. They compared the results to three control states — New Jersey, New York and Pennsylvania — that didn’t have a similar coverage scheme.

You would probably expect that more people having insurance would mean better access to primary care, meaning fewer people who would be hospitalized for avoidable conditions. However, the rates of preventable hospitalizations were practically the same in the first few years of the Massachusetts health reform, the researchers found. Further, blacks and Hispanics continued to have higher rates of hospitalization, and the disparity gap didn’t narrow in a meaningful way.

“Because the national reform is really closely based on the Massachusetts reform, the results are concerning,” said McCormick, also a primary care physician with the Cambridge Health Alliance system.

The study’s authors offer a few explanations for the results, some which pertain to Massachusetts specifically. The state already had a relatively low rate of uninsured before the reform and a robust safety net serving the uninsured — so the reform may have had little affect on how the state’s residents accessed care. The effects might have been greater in a state with a higher rate of uninsured individuals.

The findings, though, might emphasize deeper shortcomings in the health-care system that an insurance card alone won’t fix. Out-of-pocket costs for doctor visits and drugs may be preventing many of the newly insured from affording necessary primary care that would have otherwise kept them out of the hospital. Patients may have a hard time finding a doctor. And there are socioeconomic factors at play, like fewer community resources and lower levels of literary and English proficiency among the uninsured.

But the country’s health-care system is in the midst of transforming from one that rewards doctors for treating people when they get sick to one that rewards doctors for keeping patients healthier in the first place. That’s resulted in experiments that are better targeting patients in their communities and ensuring they receive care before their conditions worsen.

“Ten years ago, we wanted patients to show up — it was all upon the patient,” McCormick said. “Now there’s much more recognition of all the social factors that influence whether patients can get the care they need.”

So, maybe we are on the right track after all! That is the conversion of a system where we pay for the care of the sick to a system that provides rewards for caring for keeping patients well.

That is my theme for the new book that I am trying to research and complete. The problem is that the U.S. health care system in so based on caring for the sick, including the insurance companies/third party payers and the lawyers. How do we change the paradigm and make sure that it is sustainable?

In this great country we need to make the education of our physicians and nurses affordable, reduce the malpractice cost to the physicians so that they do the best for the patient, which eventually will be the best for the U.S. health care system. We also need a way of either penalizing the non-compliant patient or making the patients more responsible for bad behavior with regards to their health care. Social responsibility is important, but we need a system that works and the responsible citizens like you all who are interested in change and the eventual improvement in the healthcare system.

And we need to get the insurance companies either out of the health care business or neutralize their constant control of the care of the patient, physician, nursing care and the administration of the health care facilities.

Does this mean a government run program or a single payer system?

I’m not sure, considering how badly the government runs all the other systems including Medicare, which is predicted to be bankrupt in the next 10 years. Or, look at the problems with the IRS, another government system that needs a total “makeover”. We have already discussed how poorly the Medicaid, state run health care payment systems work and pay for health care and how the exchanges are failing. Why are these government run systems failures…or are they? Maybe the single payer system is the solution. But then is there needs for more qualified oversight for design, strategizing, planning, production models, analyzing what works and what doesn’t control of spending to produce the best outcomes benefiting the patient and the whole health care system? Where is the Great Society that our past Presidents were attempting to create?

So, what is the answer or what are the answers?

I am going to look critically at possible solutions. Hang in there and help me find a solution. Write back and contribute!

There are no stupid suggestions, only stupid people as Dr. Jonathan Gruber pointed out, who allowed the Affordable Care Act to be passed in the first place. If we all were more educated and involved maybe I wouldn’t be boring you all with my ranting, etc.

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