Obamacare, or, specifically, the ACA (Affordable Care Act), has, in my opinion, two excellent things to its credit. One of these things is actually good. The other is good only because of the “Laws of Unintended Consequences”.
I’ll deal with the latter first. It begins with the hue and cry, “Someone has to DO SOMETHING”. In response to the Health Care Crisis our all-wise and benevolent politicians, in order to serve the public (and to establish the necessity of their altruistic efforts to our very existence), and to FIX things…. create a LAW. The LAW makes things RIGHT. Then come the unintended consequences.
“We won’t know what’s in it ’til we pass it.” – The Hon. Nancy Pelosi – That’s a quote that should go down in history right alongside Marie Antoinette’s “… let them eat cake!” Well, we are now finding out what’s in it as new flying-by-the-seat-of-your-pants regulations are being written daily (as authorized by the ACA). One thing we are finding out: as many people are being priced out of insurance coverage as are getting coverage.
Well, I knew, as did just about anyone who knows that “Managed Care” as a model just doesn’t work (I’ll have much more to say in a series of future blogs). Obamacare simply doubles down on a medical-administrative model that was already failing… and puts the crack administrators of the IRS in charge of it to boot!
Herein lies the first good thing about Obamacare (albeit that unintended one): It will hasten the demise of an already failing medical/financial system. There are a lot of bright minds working on better free-market models that I hope in my lifetime will result in better more affordable care for all Americans.
Okay, now on to the actual good thing about Obamacare: It mandates “Wellness Coverage” for Medicare and Private Payers alike. Wellness coverage is something that all people in healthcare agree is a good idea. A dollar spent today on prevention will save hundreds tomorrow in sick care. “A stitch in time saves nine.” (I’m embarrassed to say that the syntax of this proverb escaped me and I couldn’t figure out what it meant until I was a young adult).
But when I complained to Aetna twenty five years ago that they were not paying me to do prevention – the thing that was most cost-effective for patients and for the insurance industry as well – and that they refused to reward me financially as a primary care doctor for doing more to keep patients well than they would for me just to be a “Gatekeeper” referring people into the more expensive specialist system, their practical financial answer was this: “Why would Aetna pay for prevention on a group of patients today when that same group will be covered by Blue Cross tomorrow?
It’s a logic based upon only one thing: We (the Insurance Companies) are more interested in having the money transactions of health care flow through our hands than we are about real healthcare.
So, you see, prevention only makes sense to the insurance carriers if they all agree to do it at all once… something that would never have happened if it were not for the ACA.
So, that’s one good thing about Obamacare in reality.
I hope to be doing more to keep you well in the future. I believe that even if Obamacare dies or is repealed, preventive care will stay.
It just makes sense.