February 17, 2012
By Richard Afable
When Washington came up with the Patient Protection and Affordable Care Act, it forgot one key component: The "care" part.
This spring, the U.S. Supreme Court will hear arguments about the constitutionality of the law's individual mandate requiring people to be insured. The court will decide whether the government can compel people to become consumers against their will. While this is an important debate, what truly concerns those of us in the medical profession is how the health care reform act could ultimately leave you and your loved ones with insurance, but with no access to quality care.
There is no doubt that health care is not affordable, but this misguided law will not result in better services. It will not result in more innovative health care. And, ultimately, it will result in very few health care options for consumers at all, as providers flee a market where they can neither innovate nor effectively treat patients. Free market-based reforms would be far more successful in ensuring a future in which high- quality health care is affordable and accessible.
What's needed is innovation, not heavy-handed government intervention. Hospitals understand this. As competitors for consumers' health care dollars, hospitals have an incentive to improve patient outcomes while keeping costs down.
At Hoag, for example, our newBennett Hybrid Surgical Suite? allows diagnostic imaging and surgical procedures to be performed simultaneously in the same room. The hybrid suite provides heart and vascular patients with safer treatment, shorter hospital stays, faster recoveries and improved outcomes – reducing costs overall.
Washington claims health care reform will save over $100 billion over 10 years. What is not mentioned is that it will be mostly through cuts. And while it's budgeting these massive cuts, the government hasn't figured out how to deliver good, if not better, care for more people with $100 billion less.
The law also takes another step away from consumer-driven health care, which is the wrong direction. True, more people would be insured under this law. But, to be clear, the Affordable Care Act is really a system of payment reform and regulatory reform – not health care reform.
The law will compel 35 million uninsured people to enter the health care market. Thirty-five million more patients will arrive in waiting rooms with expectations of receiving care that, under this well-intentioned, but woefully inadequate government mandate, simply cannot be met. The people who practice medicine every day understand this. It is why, when you ask a physician or a hospital executive, "Will I have a doctor when I retire," the answer is, sadly, "Probably not."
Health care is not affordable now because it is not efficient. And it won't become efficient under a government model. (Compare the relatively short wait time at an Apple store during the Christmas season with the wait time at the DMV on a given
Tuesday.) A free-market approach would encourage the vertical integration of physicians, hospitals, insurance plans and others involved in patient care. Once providers start competing with each other for services based on price, quality and outcomes, the price tag of any given service will come closer to the cost of developing and delivering it. This approach would yield the most efficient – and affordable – outcomes.
A truly free-market approach would do more than encourage providers to lower costs. When people take ownership of their health care dollars, they take more responsibility for their health. The health savings accounts many people employ are a perfect example. It is a rather simple innovation that has the remarkable effect of putting people in charge of and responsible for their health care.
When people feel responsible for their health care purchases, they change their behavior. Who wouldn't try harder to lose weight or quit smoking when a $2,000 or $6,000 deductible is on the line? But hand the responsibility over to a government program, and you lose that individual incentive to make meaningful changes. We should give consumers more responsibility for their own health, not less.
The Affordable Care Act is particularly vexing for business leaders, small and large, who have told me that they are delaying hiring due to their uncertainty about what the act will require of them.
Recently, Andrew Policano, dean of UC Irvine's Paul Merage School of Business, and I held a small breakfast for Orange County business leaders to discuss the possible impact of health care reform. Well, it was supposed to be small. More than 500 local business leaders showed up at the Hyatt Irvine, a testament to the concern so many have about this looming sea change. It was clear to them, as it is clear to me, that the Affordable Care Act, in its current form, is pitching the nation's broken system toward more problems, not improvement.
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