I know there have been distressing things in the news recently, among them separation of families seeking to take refuge in the United States. However, I hope that our legislators will not lose sight of standing against further dismantling of the Patient Protection and Affordable Care Act (PPACA). Doing so is in the interest of all-age Americans. The legislation was the most progress we’ve made in decades to improve health care access, quality and cost. Since enacted, it has met the prime objectives of leaving fewer people uninsured and providing options for covered benefits and out-of-pocket cost limits. According to the U.S. Census Bureau, the number uninsured was 27.3 million, or 8.6 percent in 2016, down almost one million people from 2015. Having fewer uninsured individuals is less costly for all of us who pay taxes. There are other components of the PPACA that are working:
· State and federal marketplace exchanges (they are not “virtually dead”).
· No denial of coverage for pre-existing conditions.
· Coverage for dependent children up to age 26.
· Coverage of more screenings, such as Pap smears, at 100 percent of cost.
Are there more improvements needed? Of course, but improvement makes more sense than repeal, especially since no one has outlined a feasible alternative. I daresay high risk pools and association health plans proposed by President Trump and Speaker of the House of Representatives Paul Ryan are not going to be a cure-all for what ails the improved but still fragmented health care system in American (no pun intended). I think we need to move away from physician-centric care, be more concerned about population health outcomes, and encourage improved system knowledge among providers. A new small technology firm operating out of Middlebury and Burlington is working with VT health care practitioners on the latter.
Some in the U.S. claim we cannot afford universal or single-payer health care, but with our mixed private and public system, we rank among the highest countries in per capita spending for health care, 17.9 percent of gross domestic product in 2016. Yet we are not at the top for some important outcomes, at 31st in terms of life expectancy and 36th for infant mortality, according to HealthAffairs.org. Curbing spending is the greatest challenge to tackle and one that we need to approach from different directions. I’ll give just two examples. One is addressing for-profit hospitals’ goal to increase profits by filling more beds. Instead of doing that, providers and consumers alike should try to avoid hospitalization. Another is reducing spending by avoiding inappropriate tests or services. The Choosing Wisely Initiative of the American Board of Internal Medicine has worked with medical specialty societies to create “Top Five” lists of expensive diagnostic tests or treatments that are commonly ordered but do not provide substantial benefits to patients. They have also collaborated with Consumer Reports to produce posters and brochures about important health topics (e.g., Why is it not recommended to take antibiotics whenever you are ill?). Perhaps you’ve seen them in your practitioner’s office. A main objective is to encourage conversations between patients and health care providers.
Vermont ranks fourth overall in state health system performance, according to a set of 42 indicators followed by the Commonwealth Fund. Keeping the Affordable Care Act as intact as possible will help us provide quality health care services to Vermonters; in fact, access and affordability is our leading indicator at third in the nation. Our uninsured rate was much lower than the national number, at 3.7 percent for 2016. As a nation though, we can learn much from countries in Europe and Canada about how to spend less and have accessible, high-quality care. Improvement, not repeal of the PPACA, seems like the smart thing to do. If health care without escalating premiums is important to you, please let your legislators know.
Gail Regan, Ph.D., M.S., P.T. New Haven and Vermont Adaptive Ski and Sports.