Recalling the Why of Health Care Reform

By Jacob Molyneux, AJN senior editor In a brief analysis of the gradual rollout and effects so far of the Affordable Care Act (ACA) at the start of this year (“The ACA Continues to Run the Gauntlet”), I reviewed a few of the issues the law was intended to address when it was passed in 2010:

* the highest per capita expenditures of any health care system in the world

* consistently worse outcomes on measures such as infant mortality rate than most other developed nations

* increasing numbers of uninsured Americans each year, to over 50 million in 2009, the year before passage of the ACA

* unsustainable annual increases in health insurance premiums and drugs costs, leading to astonishing rates of medical bankruptcy

* a Medicare reimbursement process that rewarded the volume of care provided rather than the effectiveness of that care

These worsening issues had become impossible to ignore. No one believes the ACA is a perfect law; there were too many cooks in the kitchen for that. But it’s at least a good faith attempt to address real problems, to get a framework on the table that can potentially be improved upon.

In that article, I also took note of the legal and legislative challenges the law had weathered so far and the pending King v. Burwell case before the U.S. Supreme Court. At that time, and again today, as the Supreme Court hears arguments in the case that exploits an accident of wording to undermine the financial viability of the entire law, potentially costing up to 9 million people their insurance coverage, it’s hard not to wonder at the lack of interest in real problem solving shown by such lawsuits. As I noted then:

. . . in the absence of a proposal for a better solution (or realistic hopes of selling the U.S. public on a single-payer system), partisan attacks on the ACA—as opposed to collaborative efforts to improve aspects of the law—seem increasingly a form of vandalism and their effects likely to harm those who have already been helped.

This still seems the case, whatever the Supreme Court’s decision (expected by June) may be in King v. Burwell. Our energy and resources could be better spent, whatever our political persuasion may be.