Eighty years ago this month, the Social Security Act was signed by President Franklin D. Roosevelt. Over these several decades there have been many changes to this program and it has arguably reached a level of public acceptance unlike almost any other governmental policy in American history.
Right now, many of my generation are trying to figure out how best to use these benefits in their retirement plans.
Just like the Affordable Care Act, Social Security was resisted vigorously for years by political opponents and survived two rulings in the U.S. Supreme Court, while dramatically improving the lives of many of our most hard-working citizens. Not surprisingly, polls today show that there are still many people who don't like "Obamacare." Many of these folks, however, clearly support certain of its provisions and a significant majority of all those surveyed would prefer that the law be improved rather than repealed.
As the ACA's implementation proceeds, there are a number of outcomes that, by any measure, have to be considered positive. For instance, the uninsured rate has decreased by more than one-third. Individuals with pre-existing conditions can now get health insurance at much more affordable rates. Millions of young adults now have coverage through their parents' health plans. People with major illnesses, disabilities, or chronic diseases are no longer at risk of losing coverage due to annual or lifetime limits. And, although there are other notable factors, most experts agree that the legislation has been a major contributor to the deceleration of healthcare costs.
Now that the Supreme Court has ruled in King v. Burwell that subsidies should continue in all 50 states, will things be different? Although it may not be the end of bitter rhetoric about the ACA, it may well be the beginning of the end. Always an optimist, I foresee a not too distant time when ideological extremes will work together for some common goals in healthcare.
What can we expect?
1) Even with the recent expansion of Medicaid in Alaska, there are still 20 states that offer no health coverage to adults with income below the federal poverty level. With strong support of health insurers, hospitals, and business groups, 10 Republican governors have approved Medicaid expansion. The hope is that with bipartisan cooperation in the remaining states an additional 7 million people will gain healthcare security.
2) No political party has a monopoly on the desire to further control medical costs by improving the quality of care, avoiding unnecessary, wasteful, and potentially harmful services, and ensuring the availability of credible, transparent information about the most cost-effective treatments. The exorbitant price tag for many much-needed pharmaceuticals is also a universal concern. Finding solutions for these problems will enhance the budgets of families, businesses, cities, counties, states, and the federal government.
3) As the ACA matures and its long-term prospects seem brighter, it is hoped that more insurers will participate in the state and federal marketplaces, thereby increasing competition and making the products more affordable and of greater value. The power of the market is ready to be unleashed.
Recalling the evolution of Social Security during these four score years, it would seem that the finality of this summer's court decision has now given us the opportunity to do what the American public really wants - continuously improve this imperfect law and more confidently take on the never-ending challenge of making our healthcare system truly work for us.
As Yogi Berra once said, "The future is not what it used to be."
Dr. Dan Foster is a Charleston surgeon, a former Kanawha County senator and a Gazette contributing columnist.