Since the passage of the Affordable Care Act in 2010 and its activation in 2014, there has been a huge amount of debate about what form our health protection system should take. (I am deliberately avoiding the word health insurance.)
For many, the answer has been very plain and simple: Do away with insurance companies’ involvement in providing protection for people’s health care needs, and have the “government” take over all responsibility for coverage. That’s the Medicare for all group.
Another segment of our country fears the growing power, cost, and mismanagement that often accompanies government programs. One does not need to look much further than the pretty clumsy way the Affordable Care Act made its way into its first days of operation, with massive computer failures and an inability for people to be enrolled in a timely basis, to have fear of government mismanagement.
(Related: What COVID-19 Has Taught Me About Hospitals)
A third constituency is very much in favor of employer-sponsored coverage and bemoans the fact that the Affordable Care Act ever came into existence, with its high deductibles and cost-sharing, long wait lines, flimsy networks, and volumes of rules. The point is, with an adult population of some 200 million adults between the ages of 20 and 64, there is room for a lot of different ideas and new ground to be explored.
What’s Here Now
A branch of the U.S. Department of Health and Human Services called the Health Resources and Services Administration (HRSA) has a Health Center Program.
These HRSA Health Centers were news to me.
According to a fact sheet created by HRSA Health Centers,
For more than 50 years, Health Centers have delivered affordable, accessible, quality, and value-based primary health care to millions of people regardless of their ability to pay. Not only are Health Centers serving 1 in 12 people across the country, the Health Center Program is leading the nation in driving quality improvement and reducing health care costs for America’s taxpayers. Because Health Centers provide high quality primary care services across the country, the Health Center network is also called upon to support public health priorities such as the opioid crisis and the White House initiative, Ending the HIV Epidemic: A Plan for America.
While the description sounds pretty good, I wonder how many people knew such a program existed. I dug deep and found the budget for this specific program, and it amounts to a little over $6 billion dollars right now!
When I started to look for the locations of these Health Centers I only found three within a reasonable distance from my home.
I should note that I live on Long Island, New York, which has a population of roughly 3 million people.
What I am outlining here is a large expenditure of cash. Maybe not the trillions the government is spending these days, but with very questionable benefit. Seems like no one in the federal government has really paid attention to all the money being spent in the name of health care!
The daily barrage of information we have been getting from the news media includes a slew of initials, among them: CDC, NIH, FDA, and CMS, to name a few. Do they have anything in common besides being somewhat mysterious? The answer is they are all branches of the U.S. Department of Health and Human Services mentioned above.
The Affordable Care Act is also overseen by the U.S. Department of Health and Human Services.
The annual budget for HHS is roughly $ 1.3 trillion dollars!
Despite the fact that the coronavirus pandemic has made us somewhat immune to large sums of money, the total budget for the nation of Israel is roughly $ 116 billion in U.S. dollars, so, it’s safe to say that HHS is a pretty big organization.
Right now, in spite of all that spending, doctors’ practices are being gobbled up at an alarming rate, as they cannot compete against hospital-based medical practices. Hospitals quietly visit a medical practice and make the owners “an offer they can’t refuse: “Doctor, you will become an employee of the hospital, and, in exchange, we will simplify your life and pay you a salary.”
The net result is that doctors are now on a clock and need to see a certain number of patients every hour to satisfy their hospital employer. In the end, the patient suffers as the quality of care decreases.
If this government agency could be more efficiently run, there is no reason the government could not compete against private insurance companies rather than trying to turn them into elaborate administration and bill-paying entities.
If, back in 2009, when Barrack Obama was first elected president, he had proposed a big expansion of the Health Center program with the goal of giving people a “government option” that worked, we would be better off right now.