DR. ELSIE SCOTT
On March 26, the U.S. Supreme Court began hearing arguments about the constitutionality of the individual mandate under the Affordable Care Act (ACA), which requires all citizens to have a certain minimum of health insurance coverage or pay a fine. At the heart of the argument against the mandate is whether the federal government can force people to have health insurance. Many believe that it cannot, and view the possible repeal of the mandate as the beginning of the end for the Affordable Care Act.
But what’s really at stake is far more complex. At issue is the well-being of millions of Americans who are at the short end of the current healthcare system.
The purpose of the ACA is not to have the government become the “Big Boss of Healthcare.” ACA’s purpose is to turn around our failing healthcare system and address healthcare disparities head-on. Despite its shortcomings, the ACA is one of the prime examples of the federal government using public policy to achieve a common good.
The Organisation for Economic Co-operation and Development (OECD) reports that, in 2008, the U.S. spent more on healthcare per capita than 11 similarly industrialized countries. Our nation also had one of the highest growth rates of healthcare spending, along with the highest prescription drug costs and the highest rate of prescription drug utilization.
Hospital admission rates for three out of five chronic conditions – asthma, congestive heart failure and acute diabetes complications – were highest in the U.S. in 2007, as was the rate of lower-extremity amputations due to diabetes. On the other hand, the five-year survival rates for breast, colorectal and ovarian cancer were high, with the U.S. ranking first among eight nations in breast and colorectal cancer survival and fourth in ovarian cancer survival rates.
Less for prevention
As the information above suggests, much of our healthcare spending goes to chronic disease management. According to a May 2011 column by Kaiser Health News, three-fourths of every dollar spent on healthcare in the U.S. goes toward dealing with preventable and manageable chronic diseases, but less than 5 cents per dollar is spent on prevention.
Furthermore, many healthcare services that would be best delivered in a primary care setting often take place in the emergency room. Indeed, a significant portion of our skyrocketing healthcare costs are spent on inappropriate emergency room visits. A 2010 study by the Rand Corporation found that we spend $4.4 billion annually on emergency room visits for routine, non-urgent care, with nearly 20 percent of all visits involving minor infections, strains and fractures.
The problem of health in the U.S. is further compounded by persistent inequalities in health status, health outcomes and healthcare by race/ethnicity, income and geography. Countless research indicates that African-Americans and other people of color suffer disproportionately higher rates of morbidity and mortality from chronic disease, such as diabetes, heart disease, stroke and HIV/AIDS. While the reasons for these disparities are often debated, it is imperative that we focus intentionally on reversing them for the sake of our national growth and prosperity.
So why do we need health insurance? It is very costly to get medical care in this country without insurance coverage. The cost of providing uncompensated care is one that many providers cannot afford. Research also illustrates the dire health and financial consequences of being uninsured for individuals and the nation as a whole.
Our healthcare system is in serious need of repair. Insurance coverage and a focus on prevention are essential components for fixing it and for reversing health disparities. The Affordable Care Act includes critical provisions for doing both.
Dr. Elsie Scott is president/CEO of the Congressional Black Caucus Foundation.