Aaron E. Carroll and the Essay

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For a health care provider, any time the government reduces payments, that is less income. As a manager in a health care provider, I understand that we have to find ways to match those payment reductions with cost reductions. If we reduce service instead, there will be heck to pay from both consumers and from the government.

Remember that the objective of the ACA is to improve health care, in addition to dealing with budget problems. The plan to reduce health care spending is clear, but how organizations such as mine should achieve these reductions without increasing adverse consequences for patients is less clear in the Act. This is a criticism I have with the Act, but also with authors who choose to gloss over such problems. These are problems that will affect human lives in a real, palpable way. While more Americans will be insured, there is real concern that a blueprint has yet to be laid out to maintain high standards of care. We have enough trouble doing that in the current environment.

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If an environment of chaos and uncertainty is created, if negative feedback loops are initiated by government decree, then I have concerns. I would have liked for Mr. Carroll to point out that there are serious and legitimate concerns with the ACA, and that the success of the Act will ultimately only come when those concerns are resolved effectively. Those of us in the industry are willing to work towards this resolution, but when people write about the ACA I would like to see more balance as to the challenges it creates and the positives as well, since there are both. I hate to see the health care providers treated as some sort of afterthought in this discussion.

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