This article first appeared in Becker’s Hospital Review on August 30, 2012.
Though the United States Supreme Court may have finally put to rest any constitutional disagreements over the Affordable Care Act (ACA), the debate over health care is far from settled.
Finding critics of the landmark decision is as easy as surveying the Court itself, since each of the eight remaining justices took issue in one way or another with the majority opinion set forth by Chief Justice John Roberts.
It therefore comes as no surprise that the aftereffects of the Court’s 5-4 split have already trickled down through nearly every aspect of federal and state politics, providing more than 100 pages of partisan fodder that will ensure both sides have an ample supply of rhetoric to flame this debate for years to come. For this reason, now is the time to ask ourselves if the nation is focusing on the wrong questions. If so, the answers over which we now debate are of little value.
In many ways, the ACA is a trillion dollar gamble with a trifold agenda that attempts to address the future. At its core, the bill seeks to improve the long-term health of Americans by promoting innovation in the delivery of medicine, placing stronger emphasis on the prevention of disease and enhancing education in the adoption and maintenance of healthier lifestyles.
More often than not, however, such laudable goals are overshadowed by the fact that it also seeks to expand accessibility to the 50 million who are currently uninsured. In this light, the ACA becomes a theory without guarantee, and its success is in large part contingent upon the woefully deficient system it seeks to replace. Whether or not the United States can afford to look so far ahead in its current economic climate plays an understandably overwhelming role in this debate.
Without adequate funding for the ACA’s collection of pilot programs, preventative health care services and forward thinking research, the only remaining viable option for Congress is to reduce provider reimbursement until such time as American health care can endure. Should this occur, it will be difficult for medical schools to graduate those willing and able to honor the Hippocratic Oath with the same degree of skill and integrity exhibited by physicians today. Indeed, our newfound entitlement to health care will have little meaning if in the future there is no one left to deliver it.
While the ACA is far reaching, its primary flaws are that it lacks any meaningful mechanism to instill a sense of pride for individual health, and it fails to educate the people that they must respect their right to health care. Though Americans will likely never come to a consensus on such ethical topics as when life begins or when it should come to an end, surely few will disagree that from a practical standpoint the best way to reduce the burden on health care is to collectively live healthier lives requiring less of a demand on the system.
The alternative to this option will be the creation of a health care infrastructure that is unsustainable, resulting in fewer doctors providing inferior care. Such a fear should have been central to the health care debate from the beginning, rather than the primarily political issue of whether the individual mandate is a tax or penalty.
Now that health care reform has at last received the attention it deserves, we as a nation might consider spending less time defining lines drawn between political parties and more time examining the symbiosis between patient and provider. For thousands of years, patients have relied upon physicians to extend lives, cure disease and promote well-being. With the ACA comes a shifting of this burden from provider to patient, whose willingness to accept or reject responsibility for his or her own health may now determine the future through the ways in which we respect the right to health care.
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