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Affordable Care Act

Posted by Mathias Pollock, MPH on June 29, 2012

Today, in a landmark 5-4 ruling, the US Supreme Court upheld the constitutionality of the Affordable Care Act. This is being hailed by liberals as a victory for President Obama and staunchly criticized by conservatives as another instance of government overstepping its bounds and impinging on our basic human freedoms. But if we can put aside the partisanship (I know, difficult to do with a hotly contested election looming 5 months away) and try to view this new law as a nod towards social consciousness, not socialism, then it comes closer to a victory for the people it seeks to protect: everyone.

The US has by far the most expensive healthcare system in the world. We spend almost $8,000 per capita on healthcare, more than twice as much as other developed nations, with overall costs exceeding $2.5 trillion/year. While some of this does go towards direct patient care, another large chunk is eaten up by administrative overhead, which accounts for 19-25% of healthcare expenses, and up to 34% at for-profit hospitals. And still, an average family of four in America can expect to spend almost $3,500 in out-of-pocket healthcare costs. Scared yet? What if I told you that this average expense rate has been increasing steadily by about 6% EACH YEAR.

For all of that financial investment we should expect some quality on our returns. Unfortunately, for the majority of the population, this is not the case. The world’s most expensive healthcare system is one of the least effective. The World Health Organization ranked the US 37th in terms of quality of care. And in terms of measurable health outcomes, we rank 26th in infant mortality and 24th in the number of healthy years a person can expect to live - putting America’s healthcare system in the company of Cuba and Slovenia rather than Canada and Western European nations.

While our doctors and care providers are arguably among the best in the world (over 400,000 foreigners sought medical care in the US in 2008, spending almost $5 billion), this exceptional quality is only as good as the population that has access to it. And in the US this translates to some shocking figures. Some estimates put the number Americans with no medical insurance at 1 in 6, with another 2 in 6 considered underinsured. Read another way- half of our population is reluctant or unable to seek the basic medical care they need to stay healthy. This creates a downward spiral of increasing illness prevalence and severity, ultimately culminating in more frequent and expensive procedures and more preventable trips to the emergency room.   

Regardless of your feelings about the ACA and its insurance provisions, there is something to be said for providing basic healthcare coverage for all. Isn’t that inherent in our constitutional promise to ensure the “life, liberty and pursuit of happiness…”  A sick or suffering individual with no means to afford and/or no access to insurance would see at least one, and ultimately (either through desperation or death), all three of these inalienable rights jeopardized. How can it be that, apart from South Africa, America, with its government by and for the people, is the only developed country in the world that does not provide healthcare access for all its citizens?  

We cannot afford to avoid addressing the increasing financial and health costs of our current healthcare system. It is too heavy a burden felt by too many a person. Perhaps we can learn from Switzerland (considered by some to have the best health care system in the world), which has a subsidized premium support system that allows their citizens to shop for their own private health plan on the open market. This is remarkably similar to the provisions laid out in the ACA, once one gets away from the lighting-rod issue of a penalty tax. There will surely be growing pains and the ACA may not be the ultimate answer, but it is a step in a hopeful direction towards more equitable, accessible healthcare in America. To learn more about how the ACA will impact you, see or for a bullet point summary of positive changes, see


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