Why the ACA Fails to Improve Health Care

Do the Pros Outweigh the Cons of the Affordable Care Act?
Introduction
Before the 1970s, the majority of people held hospital insurance. For instance in the ‘40s, only a tenth of the population actually had private health insurance. Just forty years later, that trend was reversed and a little more than 10% were uninsured—everyone else had bought insurance (Morrisey, 2013). This was a result of the subsidization of care by the government, which raised the price of care and which prompted more people to seek coverage. Jobs offered coverage as an incentive to come work for them, but with the increase in premiums and deductibles more people are seeing even insurance as too expensive and are now avoiding health insurance and health care altogether. What the Affordable Care Act (ACA) did was to expand taxpayer-funded care through Medicaid and Medicare while obliging individuals to purchase insurance at rates that continue to increase by huge percentages year over year (Trish & Herring, 2015). The result of the ACA was that health care was more possible for more people—but it was anything but affordable for those who could “afford” to pay for it. Moreover, the manner of health care was still at best questionable, as Goldhill (2009) has shown: instead of practicing preventive care, providers are incentivized to merely “treat” patients, conduct unnecessary tests, and overprescribe. The latter has led directly to the current opioid crisis (Rothstein, 2017). Thus, the Affordable Care Act has not done much in the way of bringing positives to an already dysfunctional health care system; on the contrary, it has added to the problems by leading insurers to raise their premiums and deductibles to unheard of levels. This paper will show that the pros do not outweigh the cons of the ACA.
Background
The Affordable Care Act was set in motion by President Obama to address several variables that hindered the treatment and prevention illness as a result of lack of access to care (Jacobson-Vann, 2011). The ACA was meant to eliminate “lifetime and annual limits on insurance coverage” while obliging providers to engage in “preventive services,” grant “access to health insurance for individuals with preexisting medical issues,” and ensure that states had the “flexibility to establish health care programs for low income non-Medicaid eligible clients” (Jacobson-Vann, 2011, p. 100). These were the pros. And while Rosenbaum (2011) lauded the ACA as a “watershed in U.S. public health policy,” the reality was that health care had already become a profit-driven industry and that the ACA did nothing to address this issue (Matthews & McGinty, 2010). This was the main con—and it was and is a big one quite simply because the profit-driven nature of the industry undermines any pros that might be conceived by the legislation.
Why the Pros Don’t Outweigh the Cons
The profit-driven nature of the health care industry was not really addressed by the ACA and therefore no matter what the ACA does to support preventive care, the underlying nature of the industry is still oriented towards incentivized treatment (testing, medication, specialized medicine, etc) instead of towards prevention.
As Goldhill (2009) points out, the ACA fails to improve health care because it fails to address the problems of health care in the U.S. The problems are not that there is too little access to health care; the problem is that the type of care that is given is not really appropriate because the motivation for care is profit-oriented rather than patient-oriented. This fact alone makes the industry problematic as a whole. Goldhill (2009) shows clearly that the system is based on incentives that put too much emphasis on treatment rather than prevention (and even though the ACA incentivizes preventive care, it does not go far enough in removing incentives associated with treatments that are unnecessary and costly). Goldhill (2009) goes on to show that many deaths result from a failure to practice preventive care, and therefore the essence of health care reform should focus on that failure. The ACA instead focuses on treatment and government subsidies. What looks like a pro—government subsidization of health care—is actually a problem (or, in other words, a big con) because that subsidization guarantees that there will be a payer. When there is a demand for a service, prices go up—that is a basic law of economics. Moreover, wherever government gets involved, subsidizing an industry, prices go up: this can be seen in everything from education to housing.
What’s worse is that the ACA’s main so-called “positive” is really a negative: the ACA focuses on expanding the role of insurance when what it should have focused on is reducing the role of insurance and eliminating the type of financing that has turned the economic model of health care in the US into a farce that will result in prices going up even higher while health and quality care decline ever more steadily. It is almost as though the government were colluding with pharmaceutical companies to keep health care patients on drugs. And, in fact, it would appear that they are (Semuels, 2017), as lawsuits against Big Pharma accuse the drug makers of being responsible for the opioid epidemic sweeping across the U.S. The ACA has essentially supported this epidemic by subsidizing this type of treatment.
Goldhill (2009) suggests that “the most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system.” Goldhill (2009) advocates a free-market system of health care as well as direct subsidies to those who cannot afford care instead of to those who provide care, which would arguably assist in cutting off the head of the profit-driven snake that masks itself as the industry today. In other words, people need to be put before profits and a more consumer-centric health care system needs to be put into place—and the ACA does not do that: it tries to play by the rules of the profit-driven industry.
The ACA was supposed to help make health care more affordable and more available to everyone—but another big con against the ACA is that part of the justification of this law was that all people would be mandated to buy insurance so that more people could be covered. The fact that not everyone has done this (because prices are still too high and paying the penalty is less expensive, especially for people who do not feel they need health care) shows how difficult it is to legislate a solution to the problem of health care costs. Health care providers are also at a loss, as they must seek reimbursement for treating patients on Medicare. Smaller hospitals are forced into consolidation—which means that the major health care providers are effectively able to create a monopoly and obtain more market power thanks to the ACA. As Cutler and Morton (2013) show, “The Affordable Care Act (ACA) reduced the growth of Medicare hospital reimbursement by about 1.5 percentage points annually, the latest in a series of payment reductions stretching back many years. Cash-strapped state governments have reduced fees to inpatient institutions. The presumed revenue enhancement from expanded insurance coverage may not occur if states choose not to adopt the ACA Medicaid offer; 26 states have stayed out initially. These financial challenges will make it even more difficult for weaker hospitals to survive on their own” (p. 1967). What this means is that the legislation passed to supposedly help people obtained better insurance has really just led to the consolidation of power in the marketplace and the means for health care organizations to develop market power and for market concentration to rear its head in a once competitive industry.
As the current trends in health care reimbursement continue to lead to this type of exodus of smaller providers from the market, the larger organizations will grow even larger. The key stakeholders in this arrangement are, of course, the legislators, lobbyists, politicians and organization leaders conspiring to ensure that the system benefits them long enough to secure their total dominance of the industry. By passing the ACA, these stakeholders were able to accomplish a monopolist’s dream. As Pope (2014) has shown, the law “accelerates the pernicious growth of market consolidation in American health care.” For the average patient, this means prices will not come down—and it means that for organizations who are resisting the pressure to merge there will be a severe lack of funds because of reimbursement policies implemented via the ACA. The smaller providers are being run out of the industry by the big corporations. Health care is being controlled by the major players who can afford to pay for lobbyists who then go to Washington to lobby for laws like the ACA that will further protect the monopolists stronghold and guarantee that prices never come down and that the very nature of the industry ever changes for the better.
The major issue in the delivery of health care in the US is that the system is protected by a government that subsidizes health care by incentivizing the providing of treatments that are often unnecessary or overly complex when instead quality preventive care should be the focus. Today’s health care system exploits patients who are viewed not as people but rather as potential profit for the industry. The ACA essentially protects this for-profit industry by obliging everyone to buy into it. Instead of supporting a vision of care for people based on ethics, the ACA supports a vision of the patient as a source of revenue.
Conclusion
The ACA came into being with a host of pros and cons: the pros suggested that the law would help make care more accessible for those who could not afford it and that “preventive care” would be promoted as Jacobson-Vann (2011) pointed out. The reality has proven otherwise: treatments and medications still represent the most subsidized form of care while preventive medicine has fallen by the wayside. The very nature of the health care industry continues to be one that is profit-driven with profits being put before people instead of the other way around. With care being subsidized, costs have skyrocketed and the insurance mandate has not helped as premiums and deductibles have also risen, making health insurance unaffordable for many people who do not have jobs that offer the kinds of insurance incentives that came into vogue decades ago. The reality of the situation is that the cons of the ACA actually outweigh the pros because on a fundamental level the ACA does nothing to address the profit-driven nature of the industry and, in fact, has done just the opposite: it has enabled the major health companies to consolidate, as smaller competitors are forced out, thus creating an environment perfect for a monopoly.

References
Cutler, D., Morton, F. (2013). Hospitals, market share, and consolidation. JAMA,
310(18), 1964-1970.
Goldhill, D. (2009). How American health care killed my father. The Atlantic.
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.
Mathews, A. W., McGinty, T. (2010). Physician Panel Prescribes the Fees Paid by
Medicare. The Wall Street Journal. Retrieved from https://goo.gl/MgzDxe
Morrisey, M. (2013). Health Insurance, 2nd edition. Chicago, IL: Health
Administration Press.
Pope, C. (2014). How the Affordable Care Act fuels health care market consolidation.
Retrieved from http://www.heritage.org/health-care-reform/report/how-the-affordable-care-act-fuels-health-care-market-consolidation
Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications
for Public Health Policy and Practice. Public Health Reports 126(1): 130-135.
Rothstein, M. A. (2017). The opioid crisis and the need for compassion in pain
management. American Journal of Public Health, 1253-1254.
Semuels, A. (2017). Are pharmaceutical companies to blame for the opioid epidemic?
The Atlantic. Retrieved from https://www.theatlantic.com/business/archive/2017/06/lawsuit-pharmaceutical-companies-opioids/529020/
Trish, E. E., & Herring, B. J. (2015). How do health insurer market concentration and
bargaining power with hospitals affect health insurance premiums?. Journal of Health Economics, 42, 104-114.