Amidst the drama of government shut down earlier this month, the US managed to roll out Obamacare (Patient Protection and Affordable Care Act). Americans without medical insurance are now able to call or log onto Health Insurance Marketplaces, which are either state or federal government run exchanges selling affordable policies. In a country that has been a champion of individual freedom and responsibility, this is certainly a watershed moment. One of the biggest changes it brings about is that medical insurance coverage no longer can be denied to those with pre-existing conditions. The act mandates the insurance companies to decrease their administrative costs and profits as percentage of the premiums charged. Additionally, it prohibits insurance companies from dropping coverage when someone becomes ill. The act also allows young adults to remain on parents medical coverage till 26 years of age. The general consensus is that while President Bill Clinton failed in his quest for wider medical coverage for Americans in the 1990s, President Barack Obama has managed to succeed in the new millennium.
However, there are shortcomings.
Obamacare is not exactly Universal Healthcare for Americans. The US congressional budget office estimates that by 2019 (when the act is fully implemented) the number of uninsured in the US will decrease by 32 million, leaving a whopping 23 million residents uninsured. These 23 million will supposedly be non-elderly residents, one third of them undocumented. The Emergency Medical Treatment & Labor Act (EMTALA) of 1986 ensures emergency treatment to all in the US. By denying routine medical coverage to a significant percentage of the population, the US is likely to continue to bear the astronomical cost of emergency care in lieu of cheaper, preventive and more effective care for these uninsured individuals. Obamacare also does not address several factors that have made the US healthcare system by far the most expensive one when compared to the rest of the world. Examples include high costs charged for medications by pharmaceutical industries, widely prevalent practice of defensive medicine in the face of high rates of medical malpractice litigation and high cost of end of life care. Moreover, Obamacare is unlikely to improve the chaotic and inefficient provision of care through the managed care model that caters to a sizable percentage of the population. The acts major fault lies in that it does not seek single payer system for all or nearly all provision of healthcare. Thus, it does not do enough to negate the business aspect of medicine. The single payer model is implemented in many developed countries around the world and has proven to be the most effective one. As things stand now, it is not an acceptable alternative in a country where personal choice seems to trump all other virtues.
It will take years to know the impact of Obamacare on overall health of Americans and the US healthcare system. Initial assessment suggests that it may not turn out to be the savior that it has been touted as. However, it does seem to be a step in the right direction for a system that has been in an inexorable decline for years.
Jay Desai is a California resident and healthcare provider. Feedback: jaydsaiATyahoo.com
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