Health care spending in the United States continues to spiral — even as outcomes continue to lag behind the outcomes that are seen in other advanced industrialized countries. American citizens are significantly less healthy than their European peers and they are dying at a younger age. In addition to the real human costs of these failures, health care spending is also crippling the domestic economy and causing budget problems. The U.S. government is continuing to scramble to fund Medicare and Medicaid; and, ongoing demographic trends are only likely to make these problems worse in the foreseeable future.
A variety of potential options exist that may help reduce the deficit in the medium-term. Some of these options are more attractive than others, and some of these options will definitely have significant impacts both on individual players in the healthcare system, but also on the system as a whole. One option that is addressed is repealing the individual mandate that is part of the Affordable Care Act (Options for, 2016). This mandate forces all citizens to enroll in a minimally qualifying health insurance program. Without proof of enrollment, people are forced to pay a steep fine (Mukherjee, 2017). The argument behind this is that by requiring relatively healthier and younger people to enroll, risks and costs will be more effectively spread.
The repeal of the individual mandate has been a talking point for Republicans since the Affordable Care Act was first implemented. The conversation is often couched in an argument about consumer rights. People argue that they should not be required to purchase a good or service that they do not want. However, this conversation overlooks the fact that the Affordable Care Act, and the individual mandate, has resulted in a dramatic increase in the number of people who are insured.
If this option was pursued, the number of insured people would plummet and certain parts of the health care system would pay the price for this. The most negatively impacted organizations/institutions would be hospitals, and particularly the emergency departments at hospitals. Often, emergency departments are the last resort for people who do not have insurance; and, people with even minor problems will end up in the emergency room. For example, an uninsured person may end up being treated for strep throat at the emergency room instead of at their primary care clinic. The treatment at the emergency room can be more expensive on an order of magnitude, overwhelming a system that is already struggling to keep up. And, these costs get pushed on to other consumers (Groppe, 2017).
Even though this option would help address the budget shortfall, this improvement in the bottom line would not offset the patients who would be put at risk from a lack of insurance. Hospitals could mitigate this risk to a certain degree by opening urgent care walk-in clinics that could deal with less emergent cases. But, this is still a sub-optimal response compared with utilizing primary care providers.
Controlling the country’s budget deficit is obviously an important issue; and health care costs clearly contribute to this budget deficit. But, many proposed options come with significant downsides. As noted above, even though repealing the individual mandate would help bridge the budget gap, it would potentially put people in danger — limiting critical access to health care. And, thus, this option should be flatly rejected.
References
Groppe, M. (3 July 2017). Who pays when someone without insurance shows up in the ER? USA Today. Electronic. Retrieved from: https://www.usatoday.com/story/news...eone-without-insurance-shows-up-er/445756001/
Mukherjee, S. (20 December 2017). The GOP tax bill repeals Obamacare’s individual mandate. Here’s what that means for you. Fortune. Electronic. Retrieved from: http://fortune.com/2017/12/20/tax-bill-individual-mandate-obamacare/
Options for reducing the deficit: 2017-2026. (2016). Congressional Budget Office (CBO). Electronic. Retrieved from: https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/52142-budgetoptions2.pdf
A variety of potential options exist that may help reduce the deficit in the medium-term. Some of these options are more attractive than others, and some of these options will definitely have significant impacts both on individual players in the healthcare system, but also on the system as a whole. One option that is addressed is repealing the individual mandate that is part of the Affordable Care Act (Options for, 2016). This mandate forces all citizens to enroll in a minimally qualifying health insurance program. Without proof of enrollment, people are forced to pay a steep fine (Mukherjee, 2017). The argument behind this is that by requiring relatively healthier and younger people to enroll, risks and costs will be more effectively spread.
The repeal of the individual mandate has been a talking point for Republicans since the Affordable Care Act was first implemented. The conversation is often couched in an argument about consumer rights. People argue that they should not be required to purchase a good or service that they do not want. However, this conversation overlooks the fact that the Affordable Care Act, and the individual mandate, has resulted in a dramatic increase in the number of people who are insured.
If this option was pursued, the number of insured people would plummet and certain parts of the health care system would pay the price for this. The most negatively impacted organizations/institutions would be hospitals, and particularly the emergency departments at hospitals. Often, emergency departments are the last resort for people who do not have insurance; and, people with even minor problems will end up in the emergency room. For example, an uninsured person may end up being treated for strep throat at the emergency room instead of at their primary care clinic. The treatment at the emergency room can be more expensive on an order of magnitude, overwhelming a system that is already struggling to keep up. And, these costs get pushed on to other consumers (Groppe, 2017).
Even though this option would help address the budget shortfall, this improvement in the bottom line would not offset the patients who would be put at risk from a lack of insurance. Hospitals could mitigate this risk to a certain degree by opening urgent care walk-in clinics that could deal with less emergent cases. But, this is still a sub-optimal response compared with utilizing primary care providers.
Controlling the country’s budget deficit is obviously an important issue; and health care costs clearly contribute to this budget deficit. But, many proposed options come with significant downsides. As noted above, even though repealing the individual mandate would help bridge the budget gap, it would potentially put people in danger — limiting critical access to health care. And, thus, this option should be flatly rejected.
References
Groppe, M. (3 July 2017). Who pays when someone without insurance shows up in the ER? USA Today. Electronic. Retrieved from: https://www.usatoday.com/story/news...eone-without-insurance-shows-up-er/445756001/
Mukherjee, S. (20 December 2017). The GOP tax bill repeals Obamacare’s individual mandate. Here’s what that means for you. Fortune. Electronic. Retrieved from: http://fortune.com/2017/12/20/tax-bill-individual-mandate-obamacare/
Options for reducing the deficit: 2017-2026. (2016). Congressional Budget Office (CBO). Electronic. Retrieved from: https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/52142-budgetoptions2.pdf