From the
PRESIDENT
JOHN L . ROBERTS , MD GLMS President | john . roberts @ glms . org
SAYING GOODBYE TO OBAMACARE AND HELLO TO … WHAT ?
The Patient Protection and Affordable Care Act became law on March 23 , 2010 . The term “ Obamacare ” was originally coined by opponents of the law and has been used in a derogatory fashion by opponents ever since . The rally cry of the opponents has long been “ Kill Obamacare !”
Well , now the opponents of the law are in charge . With the seating of the new Republican-led Congress and the inauguration of Mr . Trump , the health care policies of this nation need a new name . What remains of the old law , and what is introduced as new , what is lost and what is gained , are now under the control of this new government – they now own it ! From this point forward it is no longer under President Obama ’ s control . The albatross is now around their necks .
The tendency of some of us might be to sit back and see what happens . And , if one doesn ’ t like the new law , to attach a catchy , derogatory name to it such as “ Not-So-Great- Care ” or “ The Republican Health Care Plan .” But I think we as physicians have a moral obligation to be actively engaged in the debate and to stand up for our patients and our profession . We as physicians realize that the issues surrounding health care policy in the United States are extremely complex and demand the input of our nation ’ s best minds . We physicians are some of those best minds . Most , if not all of us , recognize that outright repeal of the current law , without an alternate program in place , is folly and will lead to chaos and suffering .
I offer the following SWOT analysis of the current situation in which we find ourselves :
Strengths : More U . S . citizens are now covered by health insurance than ever before . The percentage of people without insurance fell from 16 to nine percent in the past six years . In terms of access to health care , people are no longer discriminated against because of gender or pre-existing illness . Young adults , struggling to attain the education they need to succeed in life , can stay on their parents ’ health care policy until the age of 26 . According to the Kaiser Foundation , health care premium costs for employers increased only three percent in 2015 compared to over 30 percent per year prior to the Affordable Care Act .
Weaknesses : The Affordable Care Act is costly and some say not affordable . Insurance companies have left the marketplace in some states , including Kentucky , claiming they could not make a profit , thereby creating voids in health care access and preventing competitive pricing . The health care debate issue has been highly partisan , making civil conversations difficult . The mandate to purchase insurance is unpopular especially among young , generally healthy persons . Without healthy people in the risk pool , it is difficult to imagine how any form of expanded health care coverage could be paid for , short of increasing taxes .
Opportunities : Re-opening this can of worms to have a mature discussion about the health care policies of this nation presents the opportunity to address the broadest array of health policy issues . Topics could include , in addition to access and affordability of health care for the maximum number of citizens , tort reform , the finance of medical school education , the funding of graduate medical education and the creation of additional residency positions , the maldistribution of physicians and access to health care in rural and inner city communities , the high cost of medicines , the variability of value , costs and safety among hospitals , and the supply of and appropriate reimbursement for primary care physicians .
Threats : Our country is deeply in debt . The prevailing sentiment among the Republican-controlled legislature is to curb the debt and cut taxes . The Congressional Budget Office in June of 2015 forecasted that repeal of the Affordable Care Act would increase the deficit up to $ 353 billion over the next decade and the number of people with insurance would fall by 24 million . The Rand Corporation independently predicted that in 2018 alone , Mr . Trump ’ s campaign ’ s health plan would add an additional $ 6 billion to the deficit and decrease the number of insured by about 20 million people . The uncertain and potentially tumultuous future poses the greatest threat to our economy and health care .
We need to recall what Charles Mayo , a founder of the Mayo Clinic , said in 1919 , “ It is a poor government that does not realize that the prolonged life , health and happiness of its people are its greatest asset .” We need to protect that asset at all cost .
I call upon you to get engaged . Call your senators and representatives . Contribute to the conversation . Join the AMA , the KMA and GLMS and contribute to their Political Action Committees . The outcome of this debate will affect your practice and determine your patients ’ access to affordable health care . The health care policies created by this new government will affect the lives of you , your sons and daughters , and your grandsons and granddaughters .
Dr . Roberts is a neonatologist with the University of Louisville Physicians and the Vice Dean for Graduate Medical Education and Continuing Medical Education at the University of Louisville School of Medicine .
FEBRUARY 2017 5