Thursday, September 2, 2010

How Can We Continue Defending The Status Quo?

One might hope that, in the six months since the Patient Protection and Affordable Care Act (ACA, much derided by opponents as “Obamacare”) was passed and signed into law, opponents of the legislation might have had time to assess the law’s reforms and start focusing on constructive criticism.  After all, even those who supported the push for health care reform feel that the ACA is an imperfect law.  Unfortunately, as shown in a recent opinion piece in the Wall Street Journal, ACA opponents continue to dredge up the same tired and dishonest arguments that argue for continuing the status quo at the cost of patients’ health and wellness.

The writer’s arguments suffer from many flaws and fallacies, and having limited space I have chosen to focus on just a few:

•    Claiming the ACA will interfere with doctor-patient interactions, and that doctors will be beholden to a vaguely defined federal bureaucracy is untrue.  It is likely that physicians and hospitals will need to prove quality care (not just quantity care), but I would hope physicians would be comfortable with this so long as the quality measures are fair and relevant.  At the same time, the writer ignores that fact that for-profit health insurance companies base physician payments on similar measures and that physician decisions are daily affected by limits imposed by health insurance companies.

•    There is no part of the ACA, to my knowledge, that rations care.  Even under Dr. Berwick’s guidance, there is no evidence that there is any intent for rationing care.  Meanwhile, the for-profit insurance companies that control our dysfunctional system ration care every single day.  Apparently, Dr. Scherz either does not experience this or chooses to ignore it.

•    The writer laments that the ACA will reduce the development of new technologies and “miracle drugs”.  He ignores the fact that much of our American health care system’s focus on technology increases costs dramatically while providing little evidence that patient care and wellness is improved and that much of the development of new medications occurs in publicly-funded universities. 

•    Republican senators indeed voted uniformly against the ACA.  However, this has not stopped them from claiming credit for some of the bill’s most popular elements including coverage for preventive care services.  In fact, if you remove the “Obamacare” label from the ACA and ask Americans if they support the individual provisions in the bill, a great majority support all the bill’s provisions and even the majority of self-identified Republicans support nearly all the bill’s reforms.

•    The final point to make is the author’s claim that the United States has the best health care system in the world.  We hear this over and over and over again—despite the lack of any proof.  By most any measures, American health care lags behind nations in terms of quality of care, accessibility of care, and patient-focused outcomes.  In fact, we rank first in only one category: cost.  We pay the most, by far, of any other nation for our health care and we get precious little benefit out of it.

I am proud to be a physician, and I consider it a privilege to care for patients—even when much of my care involves getting the best care out of our broken health care system.  To claim that the status quo is sustainable is to be oblivious to the facts, and to criticize the ACA using such dishonest rhetoric is a disservice to all our patients.

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