Affordable Care Act Strengths and Weaknesses

Introduction
The Affordable Care Act (ACA), also known as Obamacare, set about reforming the health care system in America so as to enable more people to obtain access to health care. The ACA arrived with a number of strengths and weaknesses. Altogether, the Act affected patients’ access to and quality of health care. It also impacted the cost of health care in the system. This system will discuss the ACA’s strengths and weaknesses while describing its impact on health care in America. It will also provide a discussion of how I would change and improve our current health care system from the standpoint of access, quality and cost.
Strengths and Weaknesses
While the ACA’s biggest supposed strength is the 20 million people who obtained health coverage as a result of the Act, one of the ACA’s main weaknesses is the fact that it has done little to reduce the bureaucratic red tape that causes problems for providers, facilities, and health care workers in various ways. The “competitive grants for regionalized systems for emergency care response” (ACA, 2010, Sec. 1204, 124 STAT., p. 518) that were instituted by the ACA to ensure that federal dollars went to places where they were going to be used most effectively sounds good on paper—but the reality is that Accountable Care Organizations (ACOs) that have emerged as a result have placed restrictive conditions on many providers, which in the end harms patients (Alpert, 2013.). EMS workers, for instance, must adhere to new rules that determine where they take patients, as some facilities will not accept them because of ACA and ACO restrictions that stem from the patient’s history and the facilities’ history in treating that patient. So while the 20 million newly covered patients is touted as a strength of the ACA, the reality is that there are conditions that apply. Eckstein (2013) summarizes the problem succinctly when he states that “government-provided health insurance rates of reimbursement do not lend themselves to a successful business model, especially one in which lives are on the line” (p. 2068).
Other strengths of the ACA included its goal of eliminating “lifetime and annual limits on insurance coverage” while ensuring that health care providers would offer patients “preventive services” to help stave off health issues (Jacobson-Vann, 2011, p. 100). The ACA was also meant to guarantee greater “access to health insurance for individuals with preexisting medical issues,” and compel states to have the necessary “flexibility to establish health care programs for low income non-Medicaid eligible clients” (Jacobson-Vann, 2011, p. 100). In short, the ACA’s intentions were its main strengths, but the reality of the situation has revealed the ACA’s weaknesses: ideals do not necessarily translate into good or effective policies.
The real weaknesses of the ACA were that its policies were undermined by the very essence of subsidization that sits at its core: by subsidizing health care, the ACA continues the escalation of the cost of care. While the ACA was meant to increase preventive medicine, the fact that it continues to subsidize treatments has ensured that treatments are what get implemented the most—since treatments rather than prevention are what bring in the profits (Goldhill, 2009). In other words, if the ACA really intended to make health care affordable, it would have done the one thing that alone could reduce costs—that is, get government out of health care; i.e., end subsidization.
The big strength that the ACA was able to tout—its granting of access to care to 20 million people—did not really address the issue of quality or cost. In fact, by guaranteeing that access, it actually diminished the likelihood of both quality and cost being efficient. Thus, its main strength is also actually its biggest weakness and the one thing that has doomed the ACA from the outset.
How I Would Improve the Current Health Care System
Access to care was the main selling point of the ACA. It was important to people because so many millions of individuals in the U.S. cannot afford health care. They either rely on government subsidized programs like Medicaid and Medicare or they purchase health insurance (either individually or through their job). When the ACA helped millions to gain coverage, it was heralded as a great success. However, the ACA continued subsidizing treatments that, as Goldhill (2009) has pointed out, are oftentimes unnecessary and costly (paid for, of course, by tax payers). By incentivizing health care providers to treat patients with lab tests, interventions, pharmaceuticals (that commonly lead to opioid addictions), the government exacerbates an already bad problem. What is worse is that fact that it does this under the guise of doing good—i.e., by getting more coverage for more people.
I would improve health care, first, by ending government subsidies of treatment. For many people, that would be a shocking move: they believe that then they will not be able to obtain any care at all. Suddenly, millions more people will have no access to care. However, by eliminating subsidies, we could eliminate the profit-driven orientation of the health care industry that has caused health care to go from a good practice to a profit-oriented big business. Today, the health care industry puts profits before people. The pharmaceutical industry works together with legislators and health care professionals to peddle drugs onto an unsuspecting public that would be better served if preventive care were practiced for their sake.
The current state of the health system could be vastly improved by implementing a policy of preventive medicine. This would considerably increase the quality of care that exists today while simultaneously driving the cost of care down. The more that preventive medicine is practiced, the less likely treatments are to be necessary. By focusing on treating patients instead of on promoting healthy lifestyles in the first place, the health care industry simply reduces the patient to a source of potential profit—seeing him as someone who will be “back for more” at some time. The patient becomes a consumer of services. This concept of health care is essentially antithetical to any actual coherent or consistent logic of health care. Putting profits before people is what is wrong with health care today—and subsidizing care encourages and promotes that faulty philosophy.
Ending subsidies would also help to drive down costs. Every time government subsidizes an industry, costs skyrocket. It has happened in the field of education: government guarantees student loans, so colleges feel fine handing out more of them to students are who ordinarily would not have qualified for admission—but since a disinterested party is guaranteeing to foot the bill, the college sees no harm in admitting the student: why pass up a chance to make a profit? While they are at it, why not raise the cost of tuition? The government is guaranteeing the loans, after all. The same has happened in housing. And the same is happening in health care. Treatments are so much more expensive in the U.S. than they are in other countries because the government has promised to pay for them. By getting the government out of health care, health care providers will be more discretionary about the types of services they provide. They will certainly think twice about providing an unnecessary lab test for a patient just on the offshoot chance that the insurance provider (if there is one) will cover the cost.
Ending subsidies also allows for real competition to flourish, which will help to ensure that only the most quality-driven providers obtain a sizeable position in the market. As costs come down and more providers are able to offer real quality care that is based on preventive medicine, more people will be able to obtain access to real health care—1) because the costs will not be so high that they must rely upon a third party to pay for the visits, and 2) because health care providers themselves will have fewer legal risks in doing their practice as it was intended to be done—for the patient’s well-being. Currently, the health care industry exists to benefit corporations, pharmaceutical producers, technology producers, legislators, lobbyists, and many others—with the patient being used as a means to an end, which is more profit.
Conclusion
Access to care, quality of care and cost of care are all intertwined in the health care industry. The fact that it has become an “industry,” however, is the issue that causes access, quality and cost to be problematic. The government supports the industry (because government and business have become intimately united in the U.S.) instead of backing off and allowing providers to actually put people before profits. Putting people before profits in an “industry” is the surest way to go broke today—especially in a market that is manipulated and controlled from a centralized bureaucracy. Ending that bureaucratic chain and promoting real preventive care is the best way to fix the health care problem of today.

References
ACA. (2010). Sec. 1204, 124 STAT. U.S. Government Publishing Office. Retrieved
from https://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf
Alpert, A. et al. (2013). Giving EMS flexibility in transporting low-acuity patients could
generate substantial Medicare savings. Health Affairs, 32(12), 2142-2148.
Eckstein, M. (2013). The ambulance industry struggles to go the distance. Health
Affairs, 32(12), 2067-2068.
Goldhill, D. (2009). How American health care killed my father. Retrieved from
https://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/
Jacobson-Vann, J.C. (2011). Slipping through the cracks of the breast and cervical cancer
prevention and treatment act of 2000- a tragic case of failed access to care. Journal of Nursing Law, 14 (3), 96-106.
Somanader, T. (2016). A look at six years of the affordable care act. Retrieved from
https://obamawhitehouse.archives.gov/blog/2016/03/23/look-six-years-affordable-care-act