A century ago, one expected to live only 47 years in the U.S. and 30 years in India or China. Today life expectancy has increased to 78 years in the US, 75 years in China and 66 years in India. This positive change, according to Barry Bloom Jacobson, Professor of Public Health at Harvard, writing in a recent supplement to the Scientific American magazine, was the result of public health programs and disease prevention rather than by modern drugs, medical devices and treatments. There were many preventive health care programs that were instituted to bring about this improvement. One example is the vaccination programs that have eliminated and controlled many life threatening infectious diseases, specially in the developing world. This has been achieved in countries like India and China. not by the growth of private insurance companies but by greater public spending.
The Affordable Care Act (ACA) takes the preventive measures in health care one notch higher. If we can focus on avoiding known risks such as smoking and poor diet, increasing access to annual physical examination, we can reduce the incidence and complications of diseases like diabetes, heart disease and cancers. The challenge in the U.S. as in developing countries like India and China, is to make these preventive health care measures affordable and accessible to all persons. India and China have chosen the use of public funds in various programs. The U.S. has decided to provide this through privately operated Insurance Exchanges and public programs like Medicaid and Medicare.
Is it going to increase costs. Yes. By how much? Andrea M. Sisko et al have published data in Health Affairs, showing that in 2009, US spent 17.3 % of GDP in health care with a projection that in 2019, with the health care reform, the total national health expenditures would increase to 19.6 % of the GDP. The authors predicted that the net increase in spending on health care, with the ACA and other legislative provisions would be 2.3% of the GDP in ten years. Their conclusion was that the increase was moderate in nature. On the other hand the ACA will ensure that 93% of the population in 2019 will have some form of insurance coverage –private or public- as compared to 85% today.
It is up to each one of us to decide, if this is worth it. Can we do without it in the richest nation of the world?