Health Care and the ACA

This is just my personal opinion not endorsed by anyone in particular. I am not a high level player in the medical system, but I am in the system and I can think and see how things affect our system. There are two separate but related issues I want to discuss.

First our current system. There is much talk of going to a socialized system by both the right and left. The implication that ACA or the left is moving towards a socialized system implies that we have a free market system. We simply do not have either system. We have a hybrid system with components of both. There is the Medicare/Medicaid portion that is partial socialized care and we have an insurance based system that has a small part of free enterprise system and then we have the most free enterprise portions of dental/podiatric/cosmetic medicine where it is more "cash and carry'. As an added complication we have a heavy handed government that makes requirements that may at times work both for and against the best interest of the patient and the medical care industry as a whole. The simplest example is the US Post Office which can't ever seem to get its head above water-not because the Post Office leadership and workers do not know how but because there are so many government regulations and stipulations. You can't run a successful business if some senator requires a post office station in "Nowheresville, TX" like I drove by last week. So medicine is a heavy regulated, but partial free enterprise system. It thus has the efficiency of neither an integrated single payer system nor a free enterprise system.

Next,cost shifting is universal and no one even knows what things cost until after the service has been delivered. The Affordable Care Act/Obamacare is a law intended to expand coverage to more US citizens, presumably without "breaking the budget." The goal of the ACA is initially contrary to its aims. To expand coverage will cost more. The law does little to address the problems of a hybrid system as noted above. The ACA is also an extremely complex bill. It is hard to fault any single party in terms of difficulty with implementation. It is so complex that no one could get it right and have a smooth lead in. Additionally almost any major governmental program will do poorly if a significant number of governmental officials are working against it.

So where do I think this leaves health care? I essentially see it between a rock and a hard place with no good options. The current hybrid system is bulky, inefficient, costly and too large. The ACA probably will not work. If the ACA does work, it still will address the issues of our large complex system. The public in general wants not just medical care, they want it to be the best and to be free. Well maybe not free but with little additional out of pocket costs. Of course this is simply not possible. Proposed options that are simple minded included making Medicare universal, but that will not work. Not at the current level of tertiary and quaternary care that we currently have. Decisions have to be made at what level of universal coverage is given if indeed universal coverage is granted. It seems to me no one has the ability to solve the healthcare problems and no one has the authority to do so.

For me, the goal is always the same-to provide the best healthcare possible and to do so as efficiently and humanely as I can. I will have to let others deal with the rest. Even if many others do not have a clue what they are doing.