I read with great interest the Dec. 2, 2013, issue of Time magazine. The cover caught my eye with a broken aspirin labeled, “Obama Care” and the headline, “Broken Promise.” The headline may lead one to believe that this piece of legislation has failed.
The actual articles related to the title story are a bit more balanced. To a long-term observer of the American health care system, the “promise” of the Obama Administration was to change the system. By this definition, the promise has been more than kept. The good, bad and ugly of the Affordable Care Act has changed the American landscape for health care and has everyone talking about how we can move forward together as a society.
The American health care system with its employer-based and insurance-backed delivery system has been broken since the early 1980s. The cost of the system has damaged the production of American goods and services around the world while the quality of our system is one of the lowest in the civilized world.
The World Health Organization ranks the U.S. as 37th in an overall rating of health systems, 35th in life expectancy and 34th in infant mortality.
America has been long overdue for a change. Although health care services here are certainly excellent for those who can afford them, the relative unavailability of basic services to the public at large has led to our poor ranking in the noted public health indicators.
America is a capitalistic society. This has been a great asset for much of our success as a world leader. Our health care system has mirrored the capitalistic mindset. The incentives of this type of system have led to great advancements in the treatment of serious medical problems. These advances have greatly improved the health of those at the top end of the capitalism scale but have served as a huge barrier for those at the other end of the scale. Countries with socialized medicine have great scores with public health measures but lack the incentives required for innovation in health care.
The Affordable Care Act is an attempt to create a hybrid of a capitalistic health care system and a socialized health care system. This will not be an easy task. It will not be accomplished by one law, by one president or in the short term future. This is really a story that started in the 1960s with Medicare and Medicaid and will unfold well into this century.
For optometry, a profession with one foot in the merchant-based optical industry and the other in the primary health care industry, these changes may be met with mixed reviews. For the practitioners who have moved into a medical-based mode, the new law will mean a host of new patients. The new program has already enrolled more than 4 million new members as discussed in my last blog. Our role has been expanded by these new changes. Basic health care has taken a giant step to becoming more of a right than a privilege in our society, and eye care has been deemed an essential service of basic health care.
So… broken promise? … Not!