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OPINION: Obamacare is step in the right direction

By Tom Dean

Wessington Springs physician

In the ongoing turmoil surrounding the implementation of the Affordable Care Act (ACA or Obamacare) it is very easy to get lost in the details, claims and counter claims. We need to step back and look at the big picture — why was all of this proposed in the first place? — and ask if we are any closer to that goal.

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The basic answer is that our current system does not work. We spend more on health care than any other country in the world, and yet we leave 40-50 million people without coverage. Our system produces some spectacular outcomes, and yet life expectancy in the U.S. ranks 33rd in the world and our infant mortality is higher than 32 other countries.

Even if we look only at the outcomes of conditions where we know that medical interventions are effective, we find that death rates in the U.S. are higher than in 23 other developed countries and nearly twice as high as they are in the best performing countries.

These findings are at best an embarrassment. At worst they represent an absolute tragedy which is felt most severely by those who are unemployed and those trapped in low wage jobs without health insurance.

Those who oppose the ACA are in effect defending the status quo since they have offered no meaningful alternative.

We hear repeatedly that the public opposes this law, but it is clear that many of the fears the public has are based on serious misunderstandings. For instance, a recent Kaiser Foundation poll showed that 42 percent of respondents believed — incorrectly — that the law established a government panel to make end-of-life decisions for Medicare beneficiaries. No such provision ever existed. Forty-two percent believed benefits for people on Medicare will be cut — also not true.

No doubt there is much that can be improved in the ACA. Nonetheless, it represents a serious move to expand coverage and it puts in place payment structures which reward efficiency and quality improvement rather than just more interventions as does the current structure. Early results suggest that, contrary to the claims of the opponents, these changes are working. The viability of the Medicare trust fund has been extended. Premiums on policies sold through the insurance exchanges are lower than was predicted (the effect of marketplace competition) and the rate of rise in health care costs this year is the lowest in several decades.

Change is disruptive — and often frightening. Transformation can be painful and there may be winners and losers. Health care costs are still too high and not nearly enough people have coverage. However, the ACA has begun to move us in the right direction. It needs to be allowed to mature while we continue to modify and improve.

-Dr. Tom Dean, of Wessington Springs, is a family physician who has practiced at the Jerauld County Community Health Center in Wessington Springs for 35 years.