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Opinion: Repealing ACA would be an unfortunate move

As the election season evolves it is clear that health care and the reform legislation passed by Congress six months ago are a central issue. Though health care reform was seen as a priority by a large majority of voters prior to the 2008 election, polls now tell us that the public has a largely negative reaction to the new legislation (often referred to as the Accountable Care Act, or ACA).

Perhaps we should not be surprised. The legislation makes major changes in a system of vital services at a time when the public is already seriously stressed by fear and uncertainty. Many of the proposed changes are poorly understood. Our existing health care system is complicated. The planned changes are numerous and complex, which serves to intensify the fear. All this is not without precedent. Medicare in its early days was highly controversial. More recently, the Medicare prescription benefit was at first confusing and wildly criticized. Nonetheless, as beneficiaries became familiar with the help it provided, their attitude changed dramatically and the benefit is now popular.

Complicating today's environment is the fact that massive amounts of misinformation have been promulgated by those who oppose change. Polls show that a significant portion of the population still believe that the ACA contains a provision for "death panels" who would allegedly determine who should receive care and who should not. No such provision exists now nor did it ever exist.

We hear alarming rhetoric about a "government takeover." In reality, care will continue to be financed primarily through private insurance companies and delivered by private providers working for the most part through privately run organizations. The government will continue to play a large role but this is hardly a "government takeover."

There is great concern about the cost of the change. Rising health care costs are indeed a very, very serious concern. With regard to the ACA, however, the projections are that it will save money when compared to the 6 to 10 percent annual rate of medical cost inflation we have seen over the last decade. The Congressional Budget Office has projected that the changes in the ACA will reduce the federal budget deficit by $130 billion over the next decade and much more in the decade that follows. The Trustees of the Medicare system have reported that implementation of Medicare savings through the ACA will extend the solvency of the Medicare Trust Fund from 2017 to 2029. All this with no cuts in traditional Medicare benefits. Medicare savings will come through a reduction in subsidies going to the insurance companies who sell Medicare Advantage plans and by slowing the rate of growth of Medicare expenditures in the future.

The opponents of reform have been shrill and aggressive in their criticisms, yet they have offered little in the way of alternatives. In fact, we often hear them exclaiming that we dare not do anything to threaten "the best health care system in the world." Such a claim about our system is not supported by any objective data. In fact, our costs are much higher than every other developed country in the world; we have 50 million people without health care coverage and our outcomes (longevity, infant mortality, recovery from treatable diseases, etc.) are significantly poorer than those in most of the developed countries with which we are compared. We clearly are not receiving "value" for the resources we invest. The proposals floated by the opponents of the ACA are few and quite modest in scope. They talk about malpractice reform and allowing purchase of health insurance across state lines. While these are reasonable moves, no serious analyst believes they get to the heart of our problems.

Bottom line: Our current system is not delivering the quality of care that our people deserve and is simply not sustainable from a cost perspective. If we are to get a system in which costs are reasonable, care is accessible and the quality of outcomes high, we need fundamental restructuring both of the way we pay for care and the way we deliver that care. In my view, the ACA sets us on a course to do just that. (It is not insignificant that the AMA and the professional societies for both family physicians and internists -- the three largest physician groups in the U.S. -- all support this legislation.)

Transitions such as this are frightening and not without pain. The ACA is not perfect. Just like Medicare, the ACA will require adjustment and modification. It is, however, an important first step in the right direction and to repeal it at this point would be a deeply unfortunate move.

Tom Dean is a longtime physician from Wessington Springs.