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The Affordable Care Act: A Missed Opportunity, A Better Way Forward PDF

246 Pages·2013·1.06 MB·English
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T A C A he ffordAble Are CT T A C A he ffordAble Are CT A Missed Opportunity, A Better Way Forward Guy b. fAGueT, Md Algora Publishing New York © 2013 by Algora Publishing. All Rights Reserved www.algora.com No portion of this book (beyond what is permitted by Sections 107 or 108 of the United States Copyright Act of 1976) may be reproduced by any process, stored in a retrieval system, or transmitted in any form, or by any means, without the express written permission of the publisher. Library of Congress Cataloging-in-Publication Data — Faguet, Guy B. The Affordable Care Act : a missed opportunity, a better way forward / Guy B. Faguet. p. ; cm. Includes bibliographical references and index. ISBN 978-0-87586-975-9 (soft cover : alk. paper)—ISBN 978-0-87586-976-6 (hard cover : alk. paper)—ISBN 978-0-87586-977-3 (ebook) I. Title. [DNLM: 1. United States. Patient Protection and Affordable Care Act. 2. National Health Insurance, United States—United States. 3. Health Care Costs— United States. 4. Health Care Reform—United States. 5. Insurance, Health— economics—United States. W 275 AA1] RA971.3 362.1068’1—dc23 2013007688 Printed in the United States TAble of ConTenTs PrefACe 1 PArT I. The u.s. heAlTh sysTeM: orIGIns And evoluTIon 7 ChAPTer 1. hIsTorICAl overvIew 11 Out-of-Pocket healthcare. 11 Health insurance is born. 14 National Health Insurance: An elusive century-old target. 18 ChAPTer 2. rooT CAuses of The sPIrAlInG heAlThCAre CosTs 23 Providers’ perverse incentives and consumers’ expectations & disincentives. 26 Commercialization of medicine. 35 The role of trial attorneys. 39 Healthcare: A supply-driven, profit-focused industry. 44 A system beset by fraud. 60 ChAPTer 3. CosT ConTrol InITIATIves 65 Managed care. 66 DRG-based payments. 68 Consumer-Directed Health Care (CDHC). 68 PArT II. The 2010 heAlThCAre reforM bIll 75 ChAPTer 4. The PolITICs And The Money behInd The bIll 77 ix The Affordable Care Act ChAPTer 5. ouTlIne of The AffordAble CAre ACT 97 An evolving process? 97 Key provisions. 102 Implementation timeline. 104 PArT III. heAlThCAre reforM froM The Ground uP 117 ChAPTer 6. The u.s. heAlThCAre sysTeM: A brIef ouTlIne 119 Is the U.S. healthcare system the best in the world? 121 World Health Report, 2000. 122 Cross-country comparisons. 124 ChAPTer 7. foreIGn And doMesTIC heAlTh Models we CAn leArn froM 133 Foreign models. 134 Arguably the Best Domestic Model: The Veterans Health Administration. 147 ChAPTer 8. An equITAble And AffordAble unIversAl heAlTh sysTeM 153 Redesigning the system structure. 157 Redesigning care delivery. 162 Redesigning the payment model. 168 Curbing malpractice litigation and political intrusion. 172 Arguments against term limits and their rebuttal. 188 Arguments in favor of term limits. 192 ConClusIons 197 endnoTes 203 Index 231 x

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The U.S. offers a high standard of medical care few countries can match. Indeed, most medical innovations originate in the U.S. and are adopted more widely and sooner than elsewhere, the FDA ensures the efficacy and safety of drugs, biological products, and medical devices, and health professionals
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