WASHINGTON, December 29, 2014 — The U.S. Department of Health and Human Services’ website lists the four strategic goals of the Affordable Care Act. Although the law is not fully implemented yet — the employer mandate kicks in for some businesses next year and for the remainder in 2016 — backers say almost every goal has been met. There are major shortfalls, however.
Strategic Goal 1 is to strengthen health care. There are six objectives under this strategic goal, which include expanding coverage, improving quality, emphasizing primary and preventative care, reducing the growth of health care cost and insuring access for all Americans.
While coverage has been expanded to perhaps 9 or 10 million of 41 million previously uninsured, it came at the expense of the other 280 million Americans who were generally happily insured.
The quality has not improved and indeed may have worsened; increasing the number of insured people while holding the supply of doctors constant must result in poorer quality. Additionally, because of higher deductibles, some insured Americans now skip routine doctor visits and expensive tests ordered by their primary care physician. This too reduces the quality of care.
While it is true that total spending on health care is rising at a slower rate than before the act was passed, the reason is not that services are less expensive but rather that people are skipping paying out-of-pocket for those services, so indeed they are spending less. Some of the reduction is also due to recessionary pressures.
Strategic Goal 2 is to advance scientific knowledge and innovation. Because the same number of doctors are seeing more patients, there is less time to devote to research. This slows innovation. Also, by placing taxes on new medical devices, the cost to research and produce these devices increases and tends to discourage innovation. Tax reductions, not tax increases, would encourage innovation.
Strategic Goal 3 is to advance the well-being of the American people. The objectives listed under this goal relate to promoting safety as well as economic and social well-being for all Americans. In addition, the goals are to promote prevention and wellness by reducing the occurrence of infectious diseases and protecting Americans during catastrophic illness. The reality is that even after full implementation, about 30 million Americans will remain uninsured.
Although the 10 million previously uninsured will see improvements in well-being, the remaining Americans will have to pay for those uninsured, thereby reducing the amount they can spend on their own care. This goal, like the entire law, does benefit a few million while becoming more costly, less convenient and less efficient for the other hundreds of millions of Americans. And if the majority who face the higher deductibles are seeing their doctors less often, their well-being is suffering.
The law has been successful at permitting people to obtain and keep coverage regardless of a pre-existing conditions and by allowing children to be medical dependents of their parents until the age of 26.
Strategy Goal 4 is almost laughable. Here the law is meant to insure efficiency, transparency, accountability and effectiveness of HHS programs. The reality thus far is that the deceptions imposed on the American people as well as the lack of accurate information provided by the HHS has meant that there is no transparency, no accountability, and the program is far from effective.
Any time the federal government is involved in a program it is never efficient. And, because the government is not motivated by profit but rather by some notion to reduce a perceived social injustice, efficiency will never occur. Without the profit motive, there is no real incentive to reduce the cost.
Objective A under this goal is to strengthen integrity by reducing improper payments and fighting fraud. It is difficult to imagine any government run program, particularly one that accounts for about one sixth of all economic activity, that is run without improper payments and without fraud. Look at the billions of dollars of fraud in the Medicare program. Look at the improper payments and gross inefficiency at the Veteran Administration hospitals.
It has been about five years since this well-intentioned but completely disastrous law has been passed. With the exception of the 10 million Americans who now have health insurance because the remaining Americans are paying them a subsidy, the ACA has failed to me its goals. It is no wonder that the majority of Americans never approved of this law and continue to express their disapproval.
Next year will likely see dramatic changes to this debacle. The changes will come from the new Congress and likely from the Supreme Court. By next summer, we will likely be debating a new health care policy that includes voices from all Americans rather than the current law which was passed without one vote from the opposing view.