Our current healthcare system is famously inefficient at addressing the problem of chronic illnesses like diabetes, heart disease, and being overweight. According to the CDC, 75% of all healthcare expenditures go toward treating mostly preventable chronic diseases. That adds up to a total of $225 billion spent per year. Aware of these huge numbers, our government is making attempts to fix this broken, expensive system. That fix has a name we all know too well: Obamacare.
You have probably already heard about the Affordable Care Act. You’ve heard all sorts of opinions on it, the good, the bad, and the ugly. But odds are, those opinions weren’t well informed. In fact, 86 percent of Americans between the ages of 25 and 64 don’t have a grasp on Obamacare.
I don’t blame them. The act is 2,409 pages- but at least it’s double spaced. It is a behemoth of a law and made up of 10 titles. Title I. Quality, Affordable Health Care for All Americans is usually the section that most people have issues with. It’s what your liberal uncle raves about and what your conservative aunt mutters angrily about to herself at the other end of the dinner table. This is because this section fundamentally changes the nature of private health insurance. But insurance reform is not the only focus of this act. In fact, the most ambitious section of the Affordable Care act is Title IV. Prevention of Chronic Disease and the Improvement of Public Health and is the section of the act that this article will most focus on.
Before the ACA was implemented, insurers were able to deny coverage to those who had pre-existing conditions. Now, the Act allows them to be covered and even goes as far to give financial incentives for hospitals and physicians to treat patients with chronic diseases. Children under the age of 19 can no longer be considered as having pre-existing conditions and can stay on their parents insurance until the age of 26, in fact.
The ACA tries to go to the root of the problem by implementing a new way to deliver healthcare through Accountable Care Organizations. Usually healthcare is very paternalistic, as in the doctor tells the patient what to do and the patient goes home and follows orders. This method does not work well with chronic diseases. The problem with chronic diseases is that the patient’s behavior has a huge effect on the outcome of treatment. Tobacco use, poor physical activity and eating habits are impossible for one physician to treat.
The key is to create a system that helps keep people well throughout their lives instead of just treating the sick. A team of doctors, specialists, and social workers work with patients and treat them throughout their lives. Also, having to explain over and over again to different providers their condition, medications, and treatment is inefficient. Accountable Care Organizations offer more coordinated care by providing a totality of care and teams of specialists.
Primary prevention is the best medicine. The healthcare industry is learning that patient involvement in their own treatment is imperative to their overall health. Engaging in healthy behaviors greatly reduces the risk for illness and death due to chronic illnesses and therefore low rates of chronic disease can be attained without drugs and expensive medical facilities. This find is unsurprising because their rates have been incredibly low in developing countries without expensive medical facilities.
The whole behavior of society is what needs to change, and to do this, our healthcare system needs to change along with it. To help with this fight against chronic illnesses, the ACA has created a National Prevention, Health Promotion, and Public Health Council that will devise a national prevention strategy. Some of those strategies include providing education to people with chronic conditions, medication management, and collecting data that measure quality. The council also encourages “evidence- based care”. This includes tests, treatments, and medication with efficient and cost-efficient track records.
As to what else this act includes, the list goes on and on. The ACA states that this will be all paid for is through a 2.3% excise tax on medical devices like heart implants and artificial joints. This adds up to $29 billion dollars. One of the drawbacks of this law is that most of the effects it will have on healthcare will not be seen for a decade or two, especially in the chronic illness area since it depends so much on lifestyle choices and behavior. Lifestyle and behavior changes do not happen overnight, especially as a society.
Also, there are many provisions in this law as well that seem to be impossible to implement, like a federally run long term care insurance program. There are new taxes as well and some employers are cutting employee hours to not have to provide health insurance. 29 million Americans still remained uninsured. The road ahead looks long and uncertain, but the ACA, though imperfect, is currently the biggest step towards treating chronic illnesses nationally.
About the Author
Ana Mandujano is an undergraduate student in the School of Public and International Affairs studying International Relations and pre-medicine. When she’s not studying for organic chemistry and strategic intelligence, she’s a Spanish interpreter for Mercy Clinic and ruining movies for everyone by pointing out historical inaccuracies. More from Ana Mandujano.