Continued attacks on ObamaCare are wasteful and unethical

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This past month was eventful for our dear friend Jim. He was beyond relieved to learn from a biopsy that he did not have prostate cancer. He had also just spent five days in the hospital due to an adverse reaction to the extraordinarily expensive medication that keeps his Crohn’s disease in check. But more than the relief of a return to health was the Supreme Court verdict in King v. Burwell that allowed him to keep his health insurance. According to Jim, who has a good salary, either the medication, which allows him to have a productive career and a happy home life; the hospitalization; or the biopsy, with its attendant facility and anesthesia fees, could have put him into debt for life. And there was no way he would have even thought to have the check-up that led to the biopsy without insurance.

{mosads}But despite his short-term relief, Jim remains worried because the Affordable Care Act (ACA) is still under constant challenge. Every member of the GOP 2016 presidential field has said he or she will make it a priority to repeal it. Even though King v. Burwell — the suit over federal subsidies that threatened to severely cripple the ACA — has been decided in favor of the status quo, the millions of people like Jim dependent on the ACA for their healthcare, not just their health insurance, can only breathe a momentary a sigh of relief.

The ACA is the single most important social program in decades. But it is still under fire from ideologues, intent on destroying it solely on principle. There are pending lawsuits, costing taxpayers millions, issued by the very people who should be finding ways to resolve the technical flaws still present in the ACA with legislation rather than wasteful litigation. Mind you, the ACA is made up of 906 pages of the law and thousands of pages of regulations. It takes little imagination to predict, in a body of work so complex, that flaws, and therefore excuses for grandstanding through legal action, will be found for generations to come. But like Medicare and Social Security, ACA seems to be here to stay.

Even a non-economist such as I can understand the societal impact that destroying this law will have, even while its opponents are ignoring the catastrophic results that would ensue. The independent and nonpartisan Congressional Budget Office (CBO) estimates that 20 million people would lose health insurance by 2016. That’s more than 6 percent of the population, or one in 16 people. Not only that, it would add hundreds of billions of dollars to the national debt, mostly by increasing the cost of covering the uninsured and a loss of control on reimbursement rates. In fairness, it also predicts a scant increase in productivity of 0.7 percent as workers would have to take on additional jobs to pay for insurance. While our unemployment rate is indeed dropping, one has to wonder where these jobs are going to come from. There is no news about millions of jobs left unfilled, particularly well-paying jobs. And anyone who has had to work more than one job simultaneously will attest to the detriment to family life, marriage stability, productivity, the quality of diet and not surprisingly, health. These effects are not considered in the report. Nor are they considered by those who seek to quash the law on the one hand and claim to support family values on the other.

The ACA is not the government simply throwing money at the problem. As suggested by the CBO report, this is the wise expenditure of money that has a return on investment, not a bridge to nowhere. ACA also requires that doctors be paid based on outcomes. We doctors have had, up to now, few incentives to focus us on how we utilize our technology, other than how much money we could make.

The other effect not considered by the report is the devastation healthcare costs are having on American families. Not only would Jim have to pay for health insurance, which he would not be able to afford in the first place, but the insurance would not have covered any of his preexisting conditions without the ACA. Prior to the ACA, one in five Americans had trouble paying their medical bills, and healthcare-related expenses were the single most common cause of bankruptcy in this country. The downstream negative economic effects of a loss of credit are immeasurable and long-lasting.

But health insurance is a matter of moral imperative, not just a matter of the economics that the opponents of the ACA seem to continue to ignore despite plentiful objective evidence. Politics aside, we as a society have determined that healthcare is a right. For better or worse, government is the only currently viable mechanism for guaranteeing rights in our American society. Civil rights do not result from free-market pressures.

Opponents to the ACA would counter that healthcare and health insurance are part of the economy and should be left to the free market to provide. Moreover, look at the long histories of systemic problems with management and financial viability in other systems that are dependent on the government, such as Medicare and Social Security.

But the free market has nearly destroyed healthcare in the U.S., making our system one of the most expensive, with some of the worst outcomes, in the world. The free market has failed miserably at guaranteeing that good healthcare is available to all. Moreover, the government is left paying the costs of emergency care, which are far higher than proactive care. The devastation to individuals and families, the drain on our economy, and the poor results even for those able to enter into the medical system, all mandate a societal and governmental approach.

Legislators should show true leadership by rallying congress and swaying public opinion to help save American lives and money by creating legislative fixes to relieve any remaining concerns about ACA. Instead, they are wasting taxpayer money with endless and irresponsible lawsuits. These serve only to throw people like Jim into healthcare limbo, while placating the political base and playing political ping-pong with Americans’ health and lives.

Seres is an associate professor of medicine and clinical ethicist at Columbia University Medical Center. He is a fellow of Columbia’s OpEd Project and a member of the medical advisory board for Consumer Reports.

Tags ACA Affordable Care Act Health insurance Healthcare Healthcare reform King v. Burwell ObamaCare Patient Protection and Affordable Care Act
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