Hood: Too much left undone

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Medical Economics editorial board member Gregory Hood, MD, shares his opinion about the Supreme Court ruling on the Affordable Care Act.

Editor's Note: We asked our editorial board members to share their opinions of the Supreme Court ruling on the Affordable Care Act. Here's what Gregory A. Hood, MD, FACP, said.

I'm rather nonplussed with the [Affordable Care Act] at the moment. Whether implemented fully or not implemented at all, the root fact is that the government is far along an unsustainable path to insolvency. Whether the ACA is repealed or implemented, healthcare and other social contract expenditures are on pace to outstrip what funds could possibly be raised by the government to pay for them.

The quoted U.S. debt is stated to be $15 trillion, but when public debt, intra-governmental debt, and commitments to future expenditures are included, the total is purported to approach $120 trillion.

Facing the economic hurdles we face, with paralysis in Washington, DC, and the potential of defunding aspects of the ACA after the election, it feels rather pointless to get too bound up in the potential impacts of the ACA. Between inter-party rhetoric, state objections, and economic impossibilities the ACA implementation, how it will look, and what its consequences are currently, feel too nebulous to garner meritorious speculation.

The ACA is a tax, so says the Supreme Court of the United States. How can the fragility of the United States recovery be expected to face the aforementioned financial burdens plus this tax when the ACA is, at best, an incomplete solution? The elements of the practice of medicine that do work currently must be sustained and supplemented through innovation. We can't stay on the path we've been on, but neither can we rely solely on the pathway of the ACA as it [currently] exists.

Change must come, such as moves within the ACA to value appropriate reimbursement, expand health coverage, and increase primary care training slots. The promises to test patient-centric care delivery and payment systems are important. However, there is too much left undone, such as tort reform and optimization of physician efficiency, to expect the ACA to cure all of the U.S. government's ills within healthcare finance.

Unless and until the American government, healthcare providers, and also the American people take a fully informed and mature approach to the financing of the government, as well as require that its policies be based on sound principles, this is all too likely to be a fruitless debate. Until a substantial dose of realism, factual knowledge, and personal responsibility as well as societal responsibility are all implemented by all stakeholders, it is as fruitful to watch the scenery from the barrel as it goes over the falls as it is to try to hand paddle the barrel out of the swift currents carrying us over the falls.

Because we face a severe primary care shortage, particularly for the style of comprehensive care that we provide in our practice, there cannot be an increase in capacity over what we currently supply. Further, even if we did try to increase capacity, then we'd still be facing the 32% cut in January from the sustainable growth rate and sequestration. Any increases we make now would only be increasing our liability once the cuts may be expected to take place.