Exploring Human Potential

The Affordable Care Act and American Exceptionalism

Posted on | January 31, 2013 | 2 Comments

Mike Magee

Six years ago, in 2007,  I wrote a piece that asked the following questions:

“If you wanted to build a new health care system — a vehicle that would transport us to wellness, productivity, security and happiness — where would you begin?  Would you work off of what we have now or build something brand new?  Would you plan into the future? How far? Would you centralize planning or decentralize it?  Would you outsource portions of the design, the financing, and the execution?  Who would you listen to?  Who would you build for?  How would you measure success?”

Continuing, I noted that, “Even asking such questions about health care is exhausting. Our system is immense and complicated, and its problems seem insurmountable at times. 45 million uninsured, spiraling health care costs, a financing system that is broken, an explosion of chronic disease, demoralized physicians, frightened patients. It can all look pretty bleak. In the face of such daunting challenges, where does one find the energy and passion to even consider the notion of building something new? “

One year later, President Obama was elected and the nation was in economic turmoil which consumed enormous human, social and financial capital. All the more remarkable that, on March 23, 2010, President Obama signed the Affordable Care Act.

For the next two years, even as changes began to take place, the law became a political football. Republicans lined up as one against it, with their Presidential candidate promising to repeal it, and Republican governors challenging it in court. On July 5, 2012, Justice Roberts announced a Supreme Court decision upholding major elements of the law. Obama won the election, and here we are today.

Lost in the full-throated rhetoric (individual mandates, states rights, American exceptionalism) has been the transformative, comprehensive, and historic nature of this legislation. Most Americans have absorbed, at least in part, that the law will extend access to affordable health insurance while requiring citizens and employers to purchase coverage or pay a penalty.

While these elements are significant, what is arguably more remarkable is the extent to which the nation’s insurance industry is called to task for historic abuses that expanded corporate profits at the expense of American citizens. The law puts in place comprehensive health insurance reforms that will roll out over the next few years.

A quick listing of the major provisions helps capture the extent of this legislative action:

Rights and Protections

Insurance Choices

Insurance Costs

65 or Older


Early Retiree Reinsurance Program (ERRP)

Of course, this is a work in progress. We face many challenges and unintended consequences ahead that, once revealed, will need to be addressed. At the same time, we need to confront short and long term financing of these programs, quality and reliability, and define better the responsibilities of the people and the people caring for the people.

Still, from this vantage point, I can not help but to feel optimistic that our President, and our government, in the middle of a debilitating financial crisis, marshaled the energy and the passion to reject the failing status quo of health care and lead positively, constructively and thoughtfully.

We now must do two things. First, we must see the transformation of the health care sector through, including the execution of an efficient, accessible and affordable delivery system with low variability and high reliability. Second, we must take this type of optimism and bold leadership and apply it to other sectors including financial, energy, education and transportation. If we can do that, it could be quite a positive and exceptional future for this still young nation.

For Health Commentary, I’m Mike Magee.


2 Responses to “The Affordable Care Act and American Exceptionalism”

  1. Edward Gamache
    February 24th, 2013 @ 8:56 am

    While you paint a good picture of the benefits of ACA you leave out the methods, means, strategies and structures to achieve all this and hold down costs. Current federal budget projections show healthcare spending exceeding 20% of GDP within ten years. Once the 20% threshold is exceeded healthcare expenditures cannot be controlled without tanking the economy. Under these circumstances, a 5% reduction in healthcare expenditures will reduce the overall economy by 1%. In order to have a real assessment of healthcare cost one must evaluate the cost of production, purchase price, and long term economic cost. Every policy since 1965 has promised improved access and quality with lower cost. This does not appear to be any different, except this time failure will lead to collapse of the system. While you list the issues of insurers, you left out the massive expenditures of academic institutions that have become mammoth organizations over the past 50 years adding new healthcare technologies well before they are cost effective.

  2. Mike Magee
    February 25th, 2013 @ 1:49 pm


    Many thanks for your thoughtful comment. The macro issues that you site are of real concern. We sometimes forget the enormous impact of health care on employment, purchasing, and family stability in small and large communities throughout our nation. As you suggest, efficiency is in the eye of the beholder. Whether grappling with ACO’s will be just another dead end (albeit with severe consequences this time), or a real exodus from the status quo remains to be seen. As for the academic centers, I believe segmenting cost of care from cost of education is on the horizon – but nearly all institutions whether teaching or community hospitals – have played a role in the health technology explosion.


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