PPACA Legislation – more than just a tax debate
With the dust having settled a bit on the legal front since the U.S. Supreme Court ruled on the Patient Protection and Affordable Care Act (“PPACA”), there has been no such settling on the media and propaganda front. Pundits and talking heads from both sides have declared both victory and travesty from Chief Justice John Roberts’ ruling on June 28, 2012. Whether the “penalty” is a tax seems to be the favorite topic of debate and scorn. However, I strongly believe it misses the point of the law and its impact on our nation’s future.
To be frank, I share the fundamental concern of many of my conservative friends about the ability of the Federal government to impose “commerce” on its citizens. This move, in my opinion, takes us down a path that I am not sure we want to explore in great depth. But I am equally concerned that our national “General Welfare” is not addressed or kept in the forefront when we allow so many Americans to be left without care or financially crippled by the cost of seeking life-saving treatment.
Our country’s political debate surrounding tax policy is bursting with claims of economic and social calamity surrounding the implementation or elimination of taxes. This has been the case since before our nation’s founding (although we often forget it was not the tax itself that caused colonists to chuck tea in Boston harbor, it was the lack of representation in the legislative body that had the power to tax; that is certainly not the case today). Calls for payment of a “fair share” of the nation’s tax bill are countered by “class warfare” and socialism. But the sad truth is that none of this has anything to do with the basic premise of PPACA and its intended consequences.
While Sen. Mitch McConnell may claim that 30 million uninsured Americans “is not the issue”, I would disagree with him and say that it most certainly is at the heart of the issue. These uninsured people still use our healthcare system. They seek care when they are ill and, without exception, use our emergency rooms for trauma care after accidents and other serious injury. The EMTALA law passed in 1986 (signed by President Reagan) gave anyone the right to emergency care. However, it did not address how this care would be paid for by those treated or by society. What transpired was an increase in the “unreimbursed” care offered by our hospitals and providers. This fact has had an unfortunate and unintended negative consequence on our nation’s healthcare tab. But this is only one facet of the complex world that is healthcare financing. The Senator then makes statements that “state high risk pools” are designed to deal with these folks. While I will reserve the right to amend this statistic, my research seems to indicate that there are only 34 such state plans and they cover only 183,000 Americans. That would seem to leave a big gap that the Senator’s plan does not contemplate.
Another refrain from many is that the PPACA has left physicians out of the debate. These folks claim that the traditional practice of medicine has “been sunk beneath the waves.” (Daniel Henninger’s Op-Ed piece in the July 5, 2012 WSJ). Henninger’s piece claims that physicians and their patients are now just “along for the ride” in “an unchartered healthcare world”. He also states that another WSJ article that examined the impact of the PPACA across the “health sector” indicated that hospitals will deal with the law’s expected $155billion in compensation cuts by making it up on “volume”. He also states that the new law will require more time to load the data needed to measure quality outcomes (PQRS) for CMS. All of this, Henninger claims, will make the doctors less focused on their patients and more focused on data dumps for “panels of experts.” Does that sound like exactly what the current system of private health insurers already asks of our physicians? And to claim that the PPACA is going to erode the core relationship between physicians and their patients ignores the hard reality of what HMOs and other health plan restrictions have imposed on patients and doctors for decades.
And if we really want to address the alarming costs of our national healthcare system, we will need to look at the costs associated with “end of life care”. But I am not sure anyone wants to take on the AARP on that matter just yet.
I strongly believe that the predictions of the end of our country and its citizen’s liberty and freedom are grossly overblown and given to demagoguery. We are not at our nation’s end. Only time will tell how this legislation impacts our people and the fabric of this nation.
About the Author
Pete Reilly is the Healthcare Practice Leader at WGA with extensive knowledge in healthcare systems, including hospitals, long-term care facilities, and medical practice groups of all sizes.