Conflation is a commonly used rhetorical ploy: combining two things that don’t belong together or using one word to imply another when they don’t exactly mean the same thing. When the Affordable Care Act was pushed through Congress, advocates conflated health care with health insurance. The act was intended to reform health insurance, not health care. And despite common associations, they aren’t the same thing.
A recently filed lawsuit claims the ACA became unconstitutional when Congress set the individual mandate tax to zero as part of the 2017 tax bill. An opposing newspaper headline, “Lawsuit could jeopardize health care for 52 million,” demonstrated both conflation and exaggeration. Assuming the lawsuit is upheld by the Supreme Court and the ACA is struck down, many insurance regulations would disappear, not insurance itself nor the doctors who actually provide the care.
Let’s separate, rather than conflate, health insurance from health care.
Start by debunking the false presumption that the uninsured do not get health care. The Emergency Medical Transport and Labor Act (EMTALA), passed in 1986, assures that seriously ill Americans get care regardless of insurance status. People have not been “dying in the streets” for more than thirty years. Just look at volume of uninsured patients who get care at no cost to them, which admittedly costs the federal government billions of dollars.
Another incorrect presumption is that those who do have insurance get proper, timely care. This too is false. Both the medical as well as surgical quality of care has been shown to be inadequate for those with government-issued health insurance. As for timeliness of care for those with government insurance, “307,000 American veterans” experienced “death by queueing,” dying while waiting in line for care. In Illinois, 752 Medicaid-eligible persons died in line due to Medicaid expansion there. Having insurance doesn’t mean you can find a provider to actually provide care.
A third conflation is healthcare with health care. As one word, “healthcare” means the system, but as two words, “health care” refers to a doctor’s actual care of a patient, a service. Many people conflate paying for health care, the service, with our massive over-spending on the system.
This year, healthcare costs for the average American family will be $28,266. That amount is nearly half (48 percent) of the median U.S. household income of $58,829. In 2018, the U.S. will spend $10,348 per capita on healthcare, which is double what most developed countries spend. In 1960, the U.S. spent 5 percent of GDP on healthcare; now we spend 18.2 percent.
There is no doubt there is over-spending. Is that money going to health care or to healthcare?
The media’s three favorite culprits are greedy are providers, gouging pharmaceutical manufacturers, and profit-mad insurance companies. But the largest single consumer of healthcare dollars is the system itself, meaning the federal government and the insurance industry.
At least 40 percent of all healthcare spending, closer to 50 percent after the ACA, produces no care! As we are slated to spend $3.5 trillion this year on healthcare, that means at least $1.4 trillion — the GDP of Australia — will be consumed by the system before it can be used for actual care. Since those “healthcare” dollars produce no patient care, they are wasted.
Suppose the ACA were overturned as the lawsuit demands. How might that affect the average American? Nancy Pelosi tells us “hundreds of thousands of people will die” in the streets for lack of insurance “because” without insurance they will get no medical care. Yet, EMTALA remains in place. In fact, access to care will likely improve. Cost of insurance will certainly go down. If the oppressive Obamacare regulations were eliminated, states would have greater flexibility to innovate and to use their limited resources more effectively to provide care. The result? Better access to care for everyone.
This commentary was originally featured in Real Clear Health on June 28, 2018.