Beyond its aim to insure millions of people who had been uninsured, the Patient Protection and Affordable Care Act is the first serious attempt in this nation to link provision of curative medical care to preventive medicine and public health. This is particularly important in South Carolina, where we tend to have very poor health outcomes compared to the rest of the nation, including very high rates of childhood and adult obesity.
Clearly, we must make fundamental changes in how we support people to lead healthier lifestyles, because it is extraordinarily expensive to simply rely on highly inefficient medical procedures to deal with largely preventable conditions such as diabetes, heart disease and cancer.
The federal law has provisions to limit non-medical uses of insurance dollars, something that should resonate well in our state, where hospital and insurance company executives often have salaries in the millions of dollars, even though we have the eighth lowest incomes in the nation. The efficiency of Medicaid compared to the current method of universal care — hospital emergency room visits — provides a solid argument for Medicaid expansion, which leaders of many affluent states accepted, but our politicians sadly rejected. South Carolina is a poor and unhealthy state that can ill afford such poor decision-making that flies in the face of the available evidence.
One way the law aims to reduce costs is by forcing insurers to improve their own efficiency in paying for services, by limiting the money spent on huge salaries, and other things besides medical care. It also mandates payment for services that have been proven to prevent the diseases that are very hard and therefore very expensive to treat, such as late-stage complications of diabetes that are rampant in South Carolina. These include screening for cervical and colorectal cancers (Cavicchia, et al. 2012). Many people — and not just those who previously did not have health insurance — benefit from prohibiting the exclusion of pre-existing conditions and age limitations on insuring dependent children, and from requiring careful consideration to end-of-life care. This also is particularly valuable in South Carolina, which has very high mortality from diseases and the second highest rate of youth unemployment in the nation.
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Those of us who are insured by the State Health Plan are already feeling the benefit of these mandated innovations. At the national level, we see very promising trends in both reductions in rates of diseases (for example, in late-stage, aggressive cancers that are hard and expensive to treat, and cause much suffering), and overall health costs.
Countries that spend money on medical and health-related services for all of their citizens have both lower health costs and much better outcomes than we see in the United States. These other systems make serious attempts to encourage individuals to curtail unhealthy behaviors, such as tobacco use, while at the same time encouraging healthy eating and physical activity and paying for medical services aimed at disease prevention, such as appropriate cancer screening. When done right, all of this occurs in an environment that supports healthy options as the default, rather than the exception. Sweden and Canada have strong government-sponsored health systems and much lower per capita health costs than we do, much better health-related outcomes, and are leaders in providing screening guidelines to the rest of the world. If South Carolina took the Affordable Care Act as a serious call to action, we could become the leader to be admired.
Rather than continuing to waste precious time and other resources trying to overturn a law that is benefiting the vast majority of Americans and could do great good in South Carolina, we would advise people to get educated regarding the implications of the law and to use this as a basis for working together to improve the public’s health. The imperative to do so is strong here in South Carolina, where we tend to have very poor health outcomes as compared to the rest of the nation.