Repeal of Affordable Care Act is Politics Playing with the Wellbeing of Americans
To many of the detractors of the Affordable Care Act (ACA), Ms. Chhem represents exactly what is wrong with this country. They resent refugees, people they see has eternally foreign and inherently un-American, getting health care insurance and other benefits that the rest of us would consider basic human rights. The repeated sentiment is that refugees should not be getting benefits while other Americans (ie white people) suffer.
Even beyond the base fact that all humans are entitled to basic healthcare, the flaws in this thought process are too numerous to address here but a quick run-down would include: assuming that there is a clear zero-sum equation somewhere that is literally taking money and resources away from white people when in reality our government ceaselessly wastes money on armed conflict in foreign countries and an over-militarized police force; a self-centered view of what one inherently deserves as an “American;” an offensively restricted definition of what it means to be “American;” and in the case of most Southeast Asian immigrants, the fact that they are fleeing political and armed conflicts that the US had a large hand in creating. In fact in Laos and Cambodia, many refugees were specifically recruited by the US Armed Forces to fight on our side and then when we lost and withdrew our troops, they were abandoned to persecution, torture, and death. The same thing is happening now to those hired to help the US invasions and occupations of Iraq and Afghanistan, as the US has pulled out of those countries it first destroyed.
The ACA is such a large and multiplex piece of legislation that binary “us versus them” statements are gross oversimplifications. It’s so complicated that people can’t even agree on how many pages it was. This makes discussions about the ACA difficult in the public sphere. The debate is either so cerebral that it’s impossible to understand or it’s so over-simplified that it’s not actually not a comment on the ACA at all, but a projection of an individual’s already existing political beliefs.
I’m a primary care physician whose main task is to care with patients. I see patients in an outpatient setting, an inpatient setting, and in long-term care facilities. I deliver babies and help patients transition to hospice. I have witnessed on a day-to-day basis, person-to-person level, the impact of the ACA on patients, doctors, and administrators.
When I say that I fear the repeal of the ACA, I’m not thinking about philosophical political concerns. Here are the three largest changes that I have seen that would be devastating to lose:
1) Transparent Monitoring of Quality Metrics that Impact Reimbursement
For all the divisiveness between classes about the ACA, the ACA’s implementation of “pay-for-performance” or quality-based reimbursement system benefits the poor and rich alike. Historically all healthcare providers and systems have been based on a “fee-for-service” model. What that means that is that folks are paid based on each episode of care. While this makes sense at first glance, it actually incentivizes poor medicine.