Progress Report on the Affordable Care Act

The Harvard Health Blog recently had a post entitled “How is the Affordable Care Act Doing?” and it is a very quick and interesting read.  The post cites a study from the New England Journal of Medicine and goes on to emphasize that while the ACA has resulted in more Americans having health insurance, it has accomplished very little.  The authors state that the ACA “will prove (to become) little more than a temporary Band-Aid for our ailing health care system…rearranging deck chairs on the Titanic”.  I couldn’t agree more.

While a slightly greater percentage of Americans now have health insurance, most are strapped with high deductible plans that, coupled with their policy premiums, make it very difficult for them to actually afford care should they need to receive it.  That doesn’t seem “affordable” to me.  Maybe they should have just called it the “Let’s Get Everybody a Crappy Insurance Policy Plan”.

Another gripe I have (oh, there are many, as you know) is that the ACA does nothing to make it more affordable for healthcare providers to deliver their care.  Seems to me one way to accomplish this is to create a reduction in the cost of providing healthcare services.  As I’ve said before, healthcare is expensive.  It’s expensive to buy but it’s also expensive to deliver.  The need for healthcare providers to offset the cost of degrees, residency and fellowship training, licensure, certification, liability insurance, continuing education, and basic business expenses such as payroll, overhead, and taxes is immense.  The authors of the Harvard blog summarize that the only real solution is for the formation of a nationalized, institutionalized health care delivery/single payor system.  I agree that this is an option and it actually makes some sense for hospitalization and most “general” services (you can define that as you like).  However, such a model becomes a much tougher fit for more specialized providers and certainly the very small business entrepreneur in healthcare will be a dying breed in such a model.  Maybe that is just something we have to accept and move on.  Perhaps the whole “non-profit” versus “for profit” designations in healthcare need further review.  How about management-heavy hospital organizations with CEO salaries that exceed that of the brain surgeons?  A lot to look at, and our faith in Big Government as a whole is not unconditional, as experience has taught the American citizen to be objective.

However, the real point I want to make is that everybody is missing the mark.  Continued rhetoric on getting more and more care to more and more people is the wrong solution to a poorly identified problem.  We, as a country, and this includes the government, the healthcare providers, the insurers, and the citizens need to focus on getting HEALTHIER!  When overwhelming data pours in on a weekly basis that tells us that a significant portion of the heart disease, strokes, diabetes, obesity, and many forms of cancer and disease are STRONGLY LIFESTYLE-RELATED, we need to get people healthy and eliminate much of the problem.  Instead of funding a multi-billion dollar illness cyclone, we have to focus on WELLNESS!!  There needs to be more governmental and insurance company support for wellness procedures/expenditures. Healthcare providers have to be empowered to spend a greater portion of their interactions with patients in education and health improvement/maintenance.  And patients (whatever we want to call someone on the receiving end of a service) need to take more ownership in their own wellness and accept that responsibility.  We’ll never eliminate all health problems, and we do need a better system for delivering all of our services, but wellness is indeed the answer.

A mentor once told me to be careful of being critical of something if you are not willing to work hard at being a part of the solution.  I put my money where my mouth, or in this case – keyboard, is…I made radical changes in what I was doing professionally to help effect this solution.  I closed my somewhat traditional outpatient sports and orthopedic physical therapy practice and established a redesigned business model geared toward wellness.  My professional journey, like most people’s, has taken shape for multiple reasons, but the main one I’m focusing on here is wellness.  I wanted to do more of what I could do to get people healthy.  I wanted to most effectively use my degrees, experiences, and passions.  So I evolved into a Wellness Facilitator and reshaped my business into one that does more on the health education and health improvement side of the continuum, and less on the breakdown/repair side.  I still do a limited amount of PT work, and I have maximized efficiency and minimized overhead.  Those savings are passed on to the consumer, and the healthcare system.  This has not necessarily been easy, but most things in life that are worthwhile take a little effort.  So my call to action is to everybody.  Let’s keep working together and really find a way not to solve a healthcare problem, but to create a wellness-based culture.

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