Policy, Politics and Global Health Trends The Affordable Care Act

The Affordable Care Act (ACA) was recently signed into law in America. This public policy impacts all citizens of the U.S.A. And has been controversial from its inception, not only because many people, who were promised by the President that if they liked their plan they could keep it, ended up having to get a new plan at a higher rate, but also because the very individuals who promoted the policy demonstrated a clear conflict of interest in doing so (Cesca, 2010).

The financial impact of the policy has been a serious one: rates have increased and people who cannot afford to buy health coverage are to be taxed if they do not buy it. Moreover the Act asserts that "healthcare is a right, not a privilege" (Rak, Coffin, 2014, p. 317). However, by "enforcing" everyone to exercise that "right," it stops being one and instead becomes a "tax" burden on American families, who may have reasons for not wishing to purchase health insurance. At the same time, it has been shown that the ACA does little to reinforce the practice of primary care physicians and instead only directs more money to specialized care, further destroying the pool of and accessibility to primary care physicians (Goodson, 2010). This essentially means that more people seeking health care will be required to pay more for "specialized" care. The ACA has, in effect, "scam" written all over it.

As Rosenbaum (2011) indicates, the Affordable Care Act (ACA) was a "watershed in U.S. public health policy" because of its aim to reduce the total number of uninsured citizens by over 50% -- resulting in coverage (whether through insurance or Medicaid) for 94% of all Americans (p. 130). Through this Act, touted by supporters as a reform, health care providers are guaranteed payments that before were simply not available for 25% of municipal hospitals "which handle mostly the poor" (Schorn, 2006). Thus, for both non-profit and for-profit hospitals, the ACA has guaranteed a better consistency with regards to client payment fulfillment. Understanding how the ACA came into being reveals even more clearly the driving motive behind the "reform."

Matthews and McGinty (2010) are quite explicit in their description of how health care services has become a profit driven arena, directed by secret panels (the cartel) which provide guidance for groups like The Centers for Medicare and Medicaid Services: "Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars" (Matthews, McGinty, 2010). This panel operates under the title of Relative Value Scale Update Committee (RUC) and essentially sets the "pricing" of health care services, indicating how much health care providers should be compensated for their work. This means they oversee the half a trillion dollars worth of Medicare money in the sense that they determine who gets a significant cut. RUC, states DeBronkart (2013), is nothing more than a "giant cabal" under directorship of the American Medical Association (AMA). And as Dr. Lee Hieb (2012), former president of the Association of American Physicians and Surgeons, has reported, the AMA has not only openly endorsed the ACA, it is "firmly behind this egregious bit of expensive and health killing legislation." Hieb notes how the AMA has become firmly embedded in the formation of government policies, providing since the 1980s an ever-increasingly complex coding system which health care providers are "required" to use when they bill insurance companies or government agencies. The AMA, essentially, has total control over how physicians interact (financially) with their clients -- which is precisely what the ACA reinforces in an even more stringently codified way.

Because RUC has advised allocating more government money to medical "specialists," Medicare coffers have been emptied (Sanghavi, 2009). Thus, the effect of collusion between AMA and government is, ultimately, exploitation of government's pocketbook. But exploiting the pocketbook to the extent that the pocketbook is completely emptied does not help anyone in the services industry. What is wanted are perpetual profits at perpetually increasing rates -- in short, a "fix" (Sanghavi, 2009). Since the "fix" only exacerbates the problem, a "patch" is needed. The answer to this exploitation? More collusion: the ACA is a law that now requires everyone to "pay into" the system -- meaning, the pocketbook, which is then raided and divided by RUC. That pocketbook is now being reloaded annually with more money than ever before. People who did not want or need health coverage have no choice but either to buy in...

Nursing is about helping people at an affordable cost, not at a cost that will make them wish they could receive care in another country. The ACA not only hurts patients, it also hurts nurses and doctors, who act as primary care givers, as they are also targets of the AMA, which wants to replenish the government's wallet and then divvy out more funds for "specialized" care givers.
As an after effect, the law, which is said to be helpful to the average American, because it provides "better" care at lower cost (Rosenbaum, 2011), actually only gives the health insurance cartel an excuse to raise rates (since it now has to cover more liabilities). This in turn prompts government to "overhaul" the legislation in an attempt to pacify the insurance lobby (the famous promise of the President to citizens that they could "keep their plan" if they liked it was quickly broken precisely for this reason). Any way one looks at it, government has become the vassal or servant of special interest groups -- in this case, the health care cartel and the health insurance cartel. What government does not serve in any sense of the word is the working class citizen it purportedly aims to "protect."

Thus, citizens feel themselves caught in the middle of a health care "crisis," as they are the ones least represented in this tug-of-war. To make matters worse, the 1945 McCarran-Ferguson Act is a virtual shield for the health care cartel, in that it exempts it from antitrust laws. Theodore Roosevelt, the famous "trust buster" in U.S. history would be hard-pressed to break the trust that the health care cartel has developed -- so entwined is it with the body of government off which it feeds. The system is essentially that of a host with an ineradicable parasite attached deep down in its intestines. To break this trust would require a complete amputation -- a potentially life-threatening operation for big government.

Add to this the fact that "price-fixing," which is essentially what RUC does for the health care services industry is illegal in America (Kurt Eichenwald (2000) described in detail the extent to which FBI agents will go to "nab" price-fixers in his book The Informant) and one can only surmise that the current system of government in the U.S. is operated by individuals who are openly breaking the law and not being punished for it. The cartels appear to understand that the "law" proper does not apply to them, since they are so entwined with the executive, legislative and judicial branches of government -- branches which oversee, craft and enforce the law. At least, that is what they are supposed to do.

What the health care "crisis" is, in the end, is a crisis of will -- all concept of justice is lost in this crisis, because the very seat of justice panders to the wills of two competing cartels, both of which, in the long run, benefit immensely from the ACA. Meanwhile, the pocketbook of the average American is depleted.

The ACA only serves to demonstrate that nothing has changed in America in the past hundred years. The Federal Reserve Act of 1913, which gave the power to print the nation's money, to a small, private cartel of bankers, showed how powerful a group of focused and determined people can be when they unite themselves with persons of authority in government. The Affordable Care Act, which is said to protect citizens just as the Federal Reserve Act was said to do (both…