Wrong Prescription? The failed promise of the Affordable Care Act

By Trudy Lieberman
Harper’s Magazine, July 2015

It’s bad enough that the A.C.A. is fattening up the health-care industry and hollowing out coverage for the middle class. Even worse, the law is accelerating what I call the Great Cost Shift, which transfers the growing price of medical care to patients themselves through high deductibles, coinsurance (the patient’s share of the cost for a specific service, calculated as a percentage), copayments (a set fee paid for a specific service), and limited provider networks (which sometimes offer so little choice that patients end up seeking out-of-network care and paying on their own). What was once good, comprehensive insurance for a sizable number of Americans is being reduced to coverage for only the most serious, and most expensive, of illnesses.

The A.C.A.’s greatest legacy may finally be the fulfillment of a conservative vision laid out three decades ago, which sought to transform American health care into a market-driven system. The idea was to turn patients into shoppers, who would naturally look for the best deal on care — while shifting much of the cost onto those very consumers.

“Wrong Prescription?”: http://harpers.org/archive/2015/07/wrong-prescription/

Harper’s Magazine has now moved Trudy Lieberman’s “Wrong Prescription?” out from behind the paywall, making it available for free.

It is an extraordinary article that explains the what, why and how we ended up with the wrong prescription for our sick health care financing system. Though a fairly long article, reading it and sharing it with others is an imperative.

The article does not dwell on what is the right prescription, but there are basically three options:

  1. Live with ACA, and try to patch the the defects. The problem with this is that the fundamental infrastructure cannot be repaired. Patches are inadequate in that the same basic structural flaws would be perpetuated.
  2. Although the Republicans keep telling us that they have a replacement plan, after five years they have been unable to agree within themselves on the specifics. That said, they have telegraphed their ideas realised, and, combined, they are basically a weaker version of the market-driven principles already incorporated in the Affordable Care Act. They would merely weaken oversight of the plans and shift even more responsibility to the patient-consumer. Being uninsured, underinsurance, and lack of affordability of adequate coverage would all worsen under their proposals.
  3. A single payer national health program – an improved Medicare for all – would finally achieve our goals of universality, affordability and accessibility while removing financial barriers through an equitable system of financing. It is the prescription we desperately need.

Take a moment this weekend to read this article and then share it with others. At the 50th anniversary of Medicare, this article is very timely. We have to fix this system once and for all, but that means that everyone must understand why ACA was the wrong prescription.