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Siri Fiebiger, Fargo, Published October 06 2012

Letter: Health act addresses inequities

The blithe dismissal of the Affordable Care Act (Obamacare) begs the fact that our health care system is terminally ill and undermining our economy. Eighteen percent of our gross domestic product goes to health care. At $8,000 a year per capita, Americans pay more than twice what anyone else in the world does. More importantly, the return on investment is pitiful.

The U.S. ranks 38th in the world in health status – a summation of life expectancy, maternal mortality, infant mortality and other health indicators. We are far behind all developed countries and many developing countries. Our unintended pregnancy rate is 40 percent, much higher than all developed countries; France is second at 30 percent.

Access, cost

No one denies the U.S. has premium technology and health care capacity, supported by cutting-edge research and education. However, access is limited. We are the only country that provides health care as a privilege, not a right. We are the only country that regards health care a free-market industry, not a service. Sixty-five percent of Americans depend on private for-profit insurance, either through work or individual policies. Private insurance is expensive, with up to 30 percent of premiums going to administrative costs, supporting the adversarial oversight we experience as consumers and/or providers.

Though far from perfect, the ACA begins to address the inequities of access that cost all of us dearly, including covering pre-existing conditions, young adults and preventive care for women. It requires eventual health care coverage for all, expanding the marketplace for insurance across state lines, and invoking personal responsibility for one’s health care – both measures long ago touted by conservatives in response to President Bill Clinton’s attempts at health care reform. The ACA also requires 80-plus percent premiums go to provision of care.

Expands Medicare

Medicare coverage under the ACA is actually expanded to cover 100 percent of preventative services, and closing the doughnut hole for Medicare prescription coverage. The $716 billion cut is of a federal subsidy to private insurers providing Medicare Advantage, which has proved more expensive than traditional Medicare, and a slowed growth rate of reimbursement to providers.

Massachusetts’ experience with universal health care coverage pointed out valuable lessons in cost containment: Increased demand for service cannot be allowed to drive up prices, utilization/service provision must be quality- and not quantity-based. Quality health care must be driven by patient and provider education regarding delivery of quality care (less technology, more communication), cost containment – focus on service vs. market mentality, less specialty and procedural reimbursement. If costs are curtailed, the 15-member IPAB will need never meet.

It’s collaborative

Experientially, North Dakotans know what high-quality care is as delivered by our rural practitioners. It’s collaborative, educational and empowering. Your provider knows you, your community and its resources, and how to utilize them appropriately. Expensive testing and referrals are utilized sparingly/wisely. We have better outcomes for less cost, a practice supported by recent studies.

Our health care crisis requires critical care both in Washington and Bismarck. Escalating costs and diminishing returns mean all shareholders must be at the table, willing to communicate and collaborate, devoid of ideologue-based gridlock that has served both sides and the American people poorly.

When he was in Bismarck, I was never able to get my House representative (District 45), Rick Berg, to respond. We need experienced coalition builders like Ryan Taylor, Pam Gulleson and Heidi Heitkamp carrying on that wisdom forged by Sens. Byron Dorgan and Kent Conrad, and Congressman Earl Pomeroy. The future health of our country’s people and its economy depend on it.


Fiebiger, MD, is a Master of Public Health and Fellow of the American College of Obstetricians and Gynecologists.