Analysis of the Affordable Care Act

The New England Journal of Medicine published an editorial about the Affordable Care Act (ACA) by former Health and Human Services Secretary Gail R. Wilensky, Ph.D. on October 18, 2012.  Dr. Wilensky is a knowledgeable source for comments but she is clearly a political player.  Her description of problems for the ACA is reasonable although her conclusion a voucher system solves the problems does not follow logically (fully understandable in this political season).  But it is worth summarizing her findings and adding a less political conclusion.

She states that US health care suffers from

  1. Millions of people go without insurance.
  2. Health care costs are rising at unaffordable rates.
  3. Quality of care is not what it should be.

Her criticism of the ACA (in summary form by this blogs author):

  1. The penalty for not purchasing insurance is too small
    (she suggests a penalty like medicare that builds up every year if a person does not comply)
  2. A lack of organization to ensure effective, high quality and affordable care.
  3. No attack on the system of reimbursement of providers, based on number of services, rather than quality and cohesive delivery.
  4. Not enough resources are put into value-based purchasing and accountable care organizations (ACO).  And, too little money is at risk for providers who fail to meet quality targets.
  5. Not enough regulatory framework to force physicians into large multispecialty groups and patients into primary care systems.
  6. No sense of urgency to make meaningful reforms take effect.
  7. Lack of clarity  on how market forces will be harnessed.
  8. Allow a 2-tier system so those who can afford more health care coverage can purchase it.
  9. Reduce the cost of health care by government action (presumably health care vouchers as proposed by congressman Ryan)

Vouchers are one way to put a maximum on how much government will pay.  But, without simultaneously attacking the other problems we just end up with low cost awful health care — not a happy outcome.



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