---- — The debate over the Affordable Care Act (ACA, known as Obamacare) seems to be a vast waste of time and energy. The act passed Congress, has been upheld by the Supreme Court, and has already done considerable good for millions of Americans.
ACA gets rid of some of the worst existing practices. Under the act, persons under age 26 can be covered by their parents’ health insurance. Under the act, persons with pre-existing conditions cannot be denied insurance. Under the act, all persons are required to carry health insurance.
Yet the argument goes on because the proponents of the act have failed to explain how it works, what it will cost, who will be affected in what fashion. That leaves openings for opponents of President Obama to attack under the cover of ignorance by the public.
Clearly the act is imperfect. It was passed by Congress which is the greatest sausage making machine in human history. It has many ambiguities that have not been resolved or even clearly identified.
If there is one underlying problem, it is the act fails to sever the tie between health insurance and health care. The idea that Medicare could be extended to all citizens runs contrary to the interests of the insurance companies that now reap great financial benefits.
None of this will lower the costs or the price of health care. It will, however, increase access to health care, which is a reasonable national goal. To lower the price of health care, one must change the way health care is provided and the accounting system behind health care pricing. Today, price does not necessarily reflect costs.
Gov. Mike Pence has been quoted as saying that no one is denied health care because he/she can always go to the emergency room. Yet, we all know that the ER is the most expensive entry point to the health care system. That is because hospitals price the expensive equipment and services of an ER into any event that takes place in an ER. If hospitals maintained clinics for non-emergency events, the prices would be lower for those events.
Indiana has been battling the federal government over Medicaid because the state does not want to spend more money on Medicaid patients. Therefore, the governor is willing to allow 300,000 Hoosiers to go without medical insurance in order to sustain a fiction. That fiction is that people, especially the poor, can shop for low priced medical insurance and services.
This is preposterous. When medical necessity arises, people will seek whatever help they can. Price is not the issue. But preventative medical attention is very price sensitive, and we cannot expect to find the poor as willing to participate in preventative care as will the well-heeled of the governor’s fantasy.
When it comes to health care, we are not dealing with a service comparable to others in the market place. Consumers of health care cannot be compared to consumers of auto oil changes. There is a market where one can shop around or even make it a do-it-yourself task. Open heart surgery is not a do-it-yourself project for a Saturday afternoon.
Morton J. Marcus is an economist, writer and speaker formerly with the Kelley School of Business at Indiana University.He can be reached at firstname.lastname@example.org.