This commentary is by Samantha Paquette, a student in UVM’s master’s in public health graduate program. She worked for UVM Medical Center triaging and scheduling patients at its outpatient orthopedic facility, worked in the state’s health care Access and Eligibility Department, and now works as a public health coordinator.
It’s no secret the cost of health care in the United States continues to grow at an alarming rate. CMS.GOV reported in 2019 (focusing on costs before the Covid-19 impact) that America spent $3.8 trillion on health care. This means the share of our economy devoted to health spending was 17.7%.
A decade earlier before the Affordable Care Act — “Obamacare” — was implemented, U.S. health care spending was reported at 17.1% of GDP (seeing a net increase of 0.6%).
That should be seen as a win, right? Wrong.
In 2010, the Affordable Care Act was implemented with three primary goals: to increase the number of insured Americans, improve quality of care, and reduce the costs of health care.
Where the ACA has fallen short in its effort to decrease the cost of health care is in the mission statement itself. We are constantly hearing of new initiatives being implemented under the ACA aimed toward making health care more affordable for consumers, but who incurs the cost if our economy’s percentage of spending is not changing?
The ACA has unintentionally created a vicious cycle, passing these costs around to the three main payers in health care (the federal government, health insurance providers, and patients). These stakeholders continue to play a giant game of “pass the cost” or “hot potato” onto one another.
It has been extensively advertised that the ACA has focused its efforts on decreasing health care costs by increasing affordability of health insurance with subsidies (funded by taxpayers) paid directly to consumers to cover monthly premiums that are charged by insurance providers.
This concept will continue to fail in reducing health care spending because insurance companies are able to increase premium rates, deductible requirements, and copay costs when consumers increase their benefit usage to offset profit loss when paying out providers for services.
When the main goal of an initiative is to influence the beneficiary to seek the least amount of care by building cost-prohibitive requirements, we are promoting the ideology of seeking treatment for illness as a last resort when it can no longer be prevented.
The ACA’s continued business plan of supporting subsidy payments for rising premium rates is only helping insurance providers to decrease their cost per beneficiary by increasing the number of insured paying into premium costs who are not utilizing benefits. To make matters worse, the government continues to dish out subsidies for services and basic medical care because the costs of these services are unaffordable to consumers — rather than seeking a solution in controlling the continuation of large rate increases in the first place.
Although impactful work and promotion of funding public health programs has been supported through other ACA initiatives and funding, the biggest problem in the U.S. health care system has not been solved. Continuing to support this type of reform will not fix the underlying issues driving the root cause of our country’s biggest health care problem: We are getting sicker.
One thing we can all agree on: It is more expensive to care for a sick person than it is a healthy one. So, what if we focused our solution on creating a system of “healthycare” instead of sick care?
The Centers for Disease Control and Prevention has reported six out of 10 Americans have at least one chronic disease, and four out of 10 have been diagnosed with two or more.
The “Plan B” in health care reform the U.S. needs to adopt and focus our resources on is one that supports improving these numbers. The National Library of Medicine reports currently only 3% of health care spending is used for preventive services. For wellness programs to work, they must be made as profitable as programs for treating illness.
America’s entire understanding of health care — and the individual responsibility each person has in protecting their future health outlook — must be promoted. The historic practice of ignoring effects that unhealthy lifestyles have in increasing the rate of chronic disease development is reckless and will continue to drive the need for costly treatments and interventions.
A plan to increase investments in supporting better preventive care benefits, providing unbiased health education, and bringing more power back to Americans in improving their quality of life is where we need to start. To start healing, to start trusting, and to start caring.
When we focus on solutions that put people over profit, the cost of health care will no longer be controlled by regulations that reward maintaining the current system, and instead foster support for innovation.
After all, isn’t that the dream this nation was founded on?
