ACA: THE NEED FOR A COMPREHENSIVE REFORM

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The Affordable Health care Act positioned at the center of the government shutdown could not have provided a better opportunity to advocate for a much-needed  healthcare reform.  I’ve given this  little thought over the years as it has laid a bit dormant on my professional bucket list for deeper research in its reform. But from the very beginning, the ACA has been a major challenge of acceptance for me initially due to the individual and employer mandates.  But those challenges extend even further as I begin to understand better what is needed. And though the mandates are no longer, there remained aspects of the policy that I felt was amiss.  And ironically, given the recent headlines on the matters of authoritarianism, I’ve always felt that the key provisions of ACA in and of itself felt of this form however  well masked for a distortion of sorts.  But it took me moment for deeper research to address it all in a  simple yet broader perspective rather than digging prematurely into its finer details necessary for a comprehensive  reform, because certainly there an order necessary for solution here. But I finally figured out what I feel is a wrong of direction.. Coincidently, this perspective  began to take much better shape right in correspondence with  the development of new  technologies as presented with artificial intelligence and the translation of quantum information science which are based on DNA in its corrected form. But in all fairness to the ACA, this knowledge base was not available just yet as it made it legislative debut, which in recognizing  this moment for reform is almost perfect.

I’d like to make this perspective as simple as possible, so please bear with me if you may, because as a macro social worker, I have a tendency to approach issues for solution first from a broader angle, then narrow it down as the finer details fall into place.

Here I will look at quality vs quantity  and how it corresponds  to Care and Cost, and in doing so point out what I think are the challenges of ACA and why it’s critical starting from the ground up for reform.

Without taking a position at this time here regarding immigration status  and the current challenges, I would like to add that the role that immigration matters positioned in context to the current  political environment is extremely unfair to the population, but also equally unfair to US citizens for reasons not yet  clearly revealed related to health.

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The mass influx of immigrants during the Democratic administration coinciding with implementation of ACA legislation gives pause to understanding why this all is happening. In 2014, the Congressional Budget office projected that at a full implementation, of 89 percent (including all U.S. residents) or 92 percent (excluding undocumented immigrants) of the U.S. population would be covered.

With immigration at the central focal point for the potential need to increase these numbers, it is not hard to see that it will ultimately come at the increasing expense of improving the quality of healthcare. So, the question that now begs is that with the increase of immigrants across the border, where are we now in that we require this for the survival of ACA without increasing the premiums necessary for a full implementation. Now the ACA desperately needs those numbers from immigrants to reach this goal. A goal that should not never been the goal without a solid plan for increasing the much desired quality of care to not just that population, but the population that is already here.  Today, the quality of healthcare and its secure and ethical delivery remain a major challenge in this country. Here, I’m going to pass on a citation for this evidence.

With the ACA policymaker positioning this population to carry out the political agenda to meet its need for numbers (quantity) and on the back end failing to provide what is needed most for something called "affordability", it not hard to see it’s continuation as ballooning social and economic disaster at one of the most critical times in history due to other underlying factors that too may be bubbling up.

Now this population in the crossfire of our diverging politics is a critical need for the tax subsidies to reduce the premiums for its sustainability and awful term of affordability. 

 

“Let me say this about “affordability" in the context of the ACA”, It has NOTHING to do with cost. Because here  I'm afraid the cost extends far beyond the savings of nickels and dimes in one's pocket because now with the increasing prevalence of disease and declining health, the lack of quality care. this solution will never be affordable..” History once warned us about ineffective diversification. 

 

But this is where I believe  culturalism and its role within individualism and a lack understanding has played a part for major distortions in providing quality health care and exacerbating the cost imbalances that weigh heavily on economy in the Unites States and for the most part will continue to do so with or without decrease in premium on insurance.. In several ways,  the ACA turns us back even further from “care” because we have not collectively nor properly addressed the most important distortions of cause and correlation in health.

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A Quick Brief : History of Healthcare Policymaking

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I’ve never been big on history, but these days reeducating myself based on what it is that I understand now is like gold. So, as we reflect on the need to effectively evolve health care policy, I can’t stress how important it is to look back in history to address circumstances based on where we are today to head in the direction upon with we need to go. But for me this takes time, and fortunately it’s been something that I’ve had a lot of lately.  But unfortunately, I’m afraid without a shift in direction for an eventual overhaul of ACA, that a real healthcare crisis is yet to come. Much of this understanding comes directly from having developed the technology based on DNA necessary see this. But history and current events are compound this understanding. 

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As a macro social worker, the history of healthcare policymaking has revealed certain patterns for the need in understanding the relevancy of optimizing population health for quality and balancing toward efficiency its cost and coverage. But the quality must present itself. One can gaze across history at key healthcare policies beginning with President John Adams “Relief of the Sick and Disabled Seaman to Franklin D. Roosevelts NHI and his Committee on Economic Security (CES) charged with protecting “the men, women and children of the Nation against certain hazards and vicissitudes of life”, continuing with Harry Truman’s  proposal of single health insurance and push final push for NHI and now the Obama Care (ACA) with former president Barack Obama.   But regarding the Affordable Care Act, I’ve long been charged with the belief that we are reversing directions away from qualifying a universal perspective and thus have reach a point of "over quantification" at the expense of care Today, is more important than ever to take a whole perspective based on universal care to solve our biggest challenges in health., because the coverage mean little if we are dying too soon.

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Collectively, these efforts point to a very valid and crucial point: that presidents and politicians alike in leadership must know and understand well enough their constituents in the deepest sense to legislate and nurture evolutionarily for the whole of system. This must happen before the implementation of critical policies in health and education. Though I’m not advocating that doctors to become presidents or presidents be researcher or social worker, the intricacy of these relationships going forward must be better tightened and harmonized  especially since  the now economic survival of this nation very well depends on it.

There can no longer any room for guesswork toward solutions in health, because as FDR's historical  statement touches upon, today’s "vicissitudes" of life is calling for it. And today these changes are rapid beyond just the influx of new populations , but also regarding a premature and consequential advancement of technology leaving the intuitive public and health providers lost within a muddled confusion. and excitement too.  But if we are not careful, the very potential that we are currently embracing here could very well teardown  the socio-economic fabrics of this country with few mechanisms and resources to rebuild.  It sounds a bit dark unfortunately its true.  It's important that we get it right and now.

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Where is the Care: Universalism vs Culturalism and its implication on Health

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For healthcare reform, the role in approach of universalism and culturalism holds both implications and opportunity for resolve. This is certainly the case today as we seek to minimize the economic impact based on the undercurrents of complexities hidden beneath the surface of the macroeconomy.  The healthcare system is well overdue to address such a policy change of which in part reflects an isolated blind spot of culturalism with the need to redirect toward a more universal understanding, one which demonstrates the applicable meaning and adjustment toward care first. It’s what connects us all as one. Yet ironically, it is here where the ACA both succeeds and fails.  With its blinded delivery for obtaining universal coverage, it has won, its popularity has gain favor,  its void and challenges in providing quality care through viable solutions of “human care” we have been and will be stuck.  But this is where new technologies based on quantum information science becomes most critical for advancement and unfortunately this is where the  politics of economics and the economics of science begin to clash.  We are here now and in many ways, stuck, between the universe and culture with important decisions to be made. 

While it’s hard at times to bring this reflection due to the popularity of ACA, honoring its message for affordability,, it’s important to look beyond this factor and ask ourselves, what will this cost if we don’t get it right now?  I’d like to believe that  people and industry alike will ultimately and naturally begin to gravitate toward policy change reflective more in fairness, equity and justice in the universal sense. This is what I hope for. But the challenge remain for a reconstruction of ACA with this current administration, and I seek to advocate and challenge too in seeing that this work gets done.  

Because going forward at it foundation, the ACA will continue to fail with or without the immediacy of subsidies demands and needs.  and here’s why.  

The legislation falls short of in all areas of the “The Triple Aim” (Berwick et. al),  the main tenets of advocacy that ACA purports to lie upon. ​ The Triple Aim is often thought to be the “Holy Grail” of Healthcare with its serving as the  main components of a high-quality, health care system. Whether one believe that is irrelevant at this point, but I'm going to reference it because this is supposedly what the ACA was build upon.

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The “Triple Aim” components include:

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 (1) improving the individual experience of care

(2) improving the health of populations

(3) reducing the per capita costs of care

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While the components included here are indeed of merit, but with today's chronic cyber security issues, the need to further develop upon them now needs to include security of information and of systems. This must be now it's number one top priority of any healthcare policy going forward not just in words but in action. Cyber security and privacy issues in healthcare, are rampant with neglect and very little is preventing it or being done about it. Unharnessed, everyone will be affected by these breaches, whether one is sick or healthy, rich or poor,  we are all at risk.  Unfortunately, the Affordable Care Act opens up too many vulnerabilities and the Democratic party leaves far too many questions on the table for a resolve and especially for the populations of which they often serve. 

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DNA, HIPAA and the role of emerging technologies in providing quality health care.

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With the recent emergence of new technologies bearing quantum information science, a new approach toward addressing healthcare is highly necessary. With a preliminary focus for reformed healthcare,  national security and privacy issues must  form the foundation of justice  due to any information provided and related to DNA. The emerging technologies based on Quantum and the tools of utilization for computation of information like AI could provide excellent opportunities for both security and the discovery of solutions. But the challenges here are massive for the understanding. The opportunity to make good for reform efforts here in healthcare requires key leadership to understand exactly what they are up against.  

For effective leadership, this  massive undertaking of effort that must take hold quickly for understanding the critical role of emerging technologies.  

For the public, there has never been a more important time to address leadership accountability from healthcare systems, research effort and public officials.  The time has come to understand your health status, protect your rights, demand justice, at any and time they are compromised everything to secure your rights of privacy at all costs. I can’t express enough how important this is.

With the times, we often miss very valuable lessons here, especially with the rapid progression of the internet, social media and digital devices. So I encourage everyone to begin taking a better look to understand the HIPAA privacy rules and laws and to advocate for reform here too when the time and opportunity presents itself. 

While the challenges ahead are real at the intersection of it all,  I'm encouraged through my own understanding of the pathways revealed, because with change we are all still learning.

In final this government shutdown offers an opportunity for clarity and understanding from both sides of the political table and should be embraced wholeheartedly for the good of all people.

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But eventually and assuredly, in my strong opinion, the Affordable Care Act (ACA) has to go to make the space for a more fair, and equitable approach toward healthcare.

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I'm  convinced in no uncertain terms  that going forward honesty, trust and transparency will rule for sound leadership.

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