Obamacare’s Better Access
is a Double-Edged Sword
Now that the initial deadline for health insurance enrollment under Obamacare’s mandated coverage requirement has passed, maybe we can all take a breath to consider what achieving its initial 7 million enrollment figure really represents.
Its opponents have a lot riding on derailing Obamcare, one way or another – so we can expect an unremitting chorus of charges about the numbers being faked, the costs being understated, the provider networks being too narrow and so on.
But put that aside for a moment and think about what it really means – beyond the politics and the dollars-and-cents. Because there’s more to consider here than just the power and money.
Let’s assume Obamcare’s here to stay – we can’t plan on existing laws being undone, after all – and will gradually encourage more Americans to find suitable health insurance meeting the law’s coverage requirements.
It’s hard to argue this isn’t good for those who are newly insured, but I’m here to argue it’s not the unmitigated good that most of us think it is. And that’s because gaining better access to a broken healthcare system is a mixed blessing at best.
If this is true (would I lie to you?), then there’s much to ponder here for all of us, not just those newly-insured under Obamacare. Indeed, it may be the only thing both sides to this contentious issue bear in common, whether they realize it – or like it – or not.
Obamacare is Light on Fixing System
And if you don’t think our healthcare system’s broken, you need to read Our Healthcare Sucks. For starters, most of the patients dying needlessly from medical errors – hundreds of thousands of them every year – already had health insurance. It didn’t protect them from harm, did it?
Just because we don’t like to think about this – and have no apparent solutions at hand – doesn’t negate the reality.
Obamacare doesn’t really grapple with major system defects like…
Fee-for-service payments to doctors and hospitals that encourage over-treatment,
Medical malpractice (see “Medical Malpractice – What Obamacare Misses“),
Appalling patient safety record with little progress fixing it, and
Medical costs that outpace inflation and consume more of our budgets than we can reasonably afford.
Obamacare is mostly about health insurance and less about healthcare delivery. It does make some efforts to make our healthcare more coordinated and to reward quality and not just quantity of medical care.
However, these fall short of the kind of healthcare reform we truly need and won’t have the dramatic impact needed to protect Americans from an overly aggressive healthcare system that can cause more harm than good. And often does.
Insured, but UNDER-Insured
And even when better access to care is a good thing – as it often is , of course – the kind of “bronze” health plans that many of the newly-insured are buying, because it’s all they can afford, will provide a compromised kind of access that further dilutes the law’s benefits.
It’s not just the narrow networks of providers – those were happening anyway and aren’t going away either – but the self-denied care the under-insured never receive because of their initial out-of-pocket costs. Until that annual deductible is reached – and that can be thousands of dollars – many with high-deductible bronze health plans will simply forego care that they actually need.
This has been the experience to date with these plans. Indeed, its their very intent – the whole idea with high-deductible plans is to discourage patient use of the system.
When that use is marginal or even unnecessary – as so much of it is – that can work out fine, as nothing of value is lost to the patient.
But when that foregone care means colon cancers go undetected, for example, because under-insured patients can’t afford to pay thousands of dollars for a colonoscopy out of their own pockets, then it’s not such a good thing.
The flip side of this concern is that many required to purchase health insurance under Obamacare for the first time may be tempted to more freely use the healthcare system since they’re already paying for some of it through their insurance premiums.
Why not? This is what many of us who’ve been insured all along have been doing all these years.
This can prove a costly mistake, however – for them and for all of us, and not just financially.
You’d think with the horrendous record of patient death and injury caused by medical malfeasance, we’d all be more cautious about relying on such a system for potentially life-and-death matters.
Tough Balancing Act
This need to find a balance between too much and too little healthcare is why we should use this breather in Obamacare’s implementation to re-think not just our health insurance needs, but our reliance on a healthcare system that too often puts profits before patients’ needs.
And much of that will continue regardless of Obamacare’s ultimate political fate.
If you’re someone with a pre-existing medical condition or are otherwise thankful you’ll now be able to access the medical system – maybe for the first time – try to temper that enthusiasm with respect for the harm that overly-aggressive medical interventions can cause.
If time permits, be sure to exhaust your conservative treatment options before agreeing to more aggressive – and higher-risk – ones.
And if you’re not so happy about Obamacare, try to think about it not with dread you’re being forced to buy something you’d rather not – if that’s your mindset – but as an opportunity to put your healthcare house in order in the safest and most cost-effective manner.
Because health insurance is just the start of our healthcare journey.
We’re the ones responsible for preventing it from turning into a nightmare.
Don’t Let Insurance
Dictate Your Healthcare
Learning to become a smart medical consumer will be your best path to acquiring the health insurance best-fitted to your needs and to assuring your reliance on the healthcare system is “right-sized” for the actual medical needs of you and your family – no more and no less.
Whatever other pluses and minuses Obamacare may evidence in the months and years to come, if it forces us to re-evaluate our use of a healthcare system that’s riddled with conflicts of interest among insurers, doctors, and hospitals, that may prove its greatest legacy.
For more in-depth information on Obamacare, see Obamacare For Smarties.