About three years ago, I was privileged to attend a national internal medicine committee discussing the proposed new ACA health care bill prior to its passing the US Congress, and during the discussion I resolutely stated, “The bill should do more to control costs.” The chairman of the committee responded, “Hey, of the two major issues: 1. Giving access for those uninsured, and 2. Controlling cost, it makes sense to start with access first. If we start with cost first, we will never get back to access.” The room went silent as the truth to his statement sank in, reflecting the ethical importance to providing some level of quality care for all and the complexity of controlling costs.
Prior to the ACA, insurance companies have had to compete by not covering or insuring sick people, and thus controlling their own costs. The major thrust of the ACA bill is to push insurance companies to cover everyone, and let those insurance companies find another way to compete and control costs.
The conversation then turned to a discussion about why Obama reformed the insurance industry, rather than simply making a single payer government system. The answer came, “Yeah, it would be less complicated, but it makes sense to encourage private enterprise rather than government to work out a better way to control costs. Too many lobbyists to expect the Federal government to do it.”
It has been more than three years since this conversation and the health care law was passed. In 2014 the ACA will advance to require insurance companies to cover everyone, even with pre-existing conditions. And to defray the cost of access to all, everyone will be required to have insurance, like what we have required for the auto industry.
There are those that argue the ACA relies too much on regulation, rather than harnessing market forces; should give insurance companies more wiggle room to control costs; and needs to be more radical in cutting certain wasteful programs. I believe these criticisms are appropriate, the ACA has room for improvement, and it can be refined. But I’m afraid if we recklessly dump the ACA to more aggressively go after the cost issue, we will likely forget the access issue, and leave millions uninsured once again.
We cannot forget the ethical importance to providing access and care for all.