If, as anticipated, the Supreme Court rules the Affordable Care Act unconstitutional, then according to experts there is a real possibility that the entire healthcare system will be thrown into financial chaos. Why? An NPR report says,
One reason is that the law (the ACA) changed the payment rates for just about every type of health care professional who treats Medicare patients. Every time Medicare sets a payment rate, it needs to cite a legal authority. And for the past two years, says Rosenbaum, that legal authority has been the Affordable Care Act.
So if the law is found unconstitutional, she says, every one of those changes “doesn’t exist anymore because the law doesn’t exist.”
And the result? “You have agencies sitting on two years of policies that are up in smoke,” she says. “Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid. Changes in coverage that have begun to take effect for the elderly, closing the doughnut hole might not happen. We don’t know.”
And many of those facilities serve not just Medicare patients but the rest of the population, too. Hence, the spillover could affect the health care system as a whole.
If in fact the government’s part of healthcare is removed or its payments reduced,
what will it then look like? I believe I have found a preview in a report by ABC News. Some dental care is covered by Medicaid, the program for the poor, but its rates are not competitive in the market. As you can see in the ABC 4-minute clip, the journalist called ten pediatric dentists’ offices in four Florida counties and did not find a single dentist willing to see a Medicaid child patient in need of immediate care. Dental care is fee for service – it’s about the money and its up to the patient to foresee that dental health is vital to one’s overall health, including not just appearance and nutrition but even affecting the heart. That takes foresight and commitment, things not always a high priority when you’re young.
It would be easy to take the position that families ought to prioritize their finances, save up and take care of this responsibility. Right. And that would apply to so many other things as well, things like regular healthcare, life insurance, and just plain savings for example. But the simple fact is that people don’t do many things they should, especially when those things require long-range planning.
When I was working, there were things I knew I should do but didn’t because I rationalized there wasn’t time. I didn’t work out every day because I was too tired. I didn’t brush my teeth after breakfast or lunch, even though that would have taken only a couple of minutes. I don’t have that excuse now, so I do those things, but it still takes an effort, a mental commitment. What I’m trying to say here is that for-profit medicine is too expensive and too neglectful of preventive public healthcare. Under a public option you would get the preventive process and you would get it for about 40% of the up-front cost of how we do it now, and further savings by not having to treat neglect as emergencies.
There is a general public prejudice against government-provided healthcare in this country. Some even consider the idea anti-American. That needs to change because healthcare under the current system, even under the ACA, is centered around money and patient through-put. It ought to be a public service supported by taxes. If we don’t change our delivery system and the Supreme Court kills the Affordable Care Act, American healthcare could soon look like dental care in Florida, or maybe like healthcare in Pakistan. (The rich there are doing just fine, thank you – the others, not so hot.)