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Another Voice: Both parties are dug into dysfunction on Affordable Care Act

By Sam Unterricht

The Affordable Care Act moves forward in its multiyear saga, with delays and numerous controversies. In the quest for a “horse” to carry American health care forward, the ACA was created by people who really would have preferred a mythical unicorn. When constructing a horse with a public program, winding up with a unicorn or even with an Arabian or Lipizzaner stallion is far too much to hope for. Certainly, though, a good reliable workhorse is necessary for something as important as health care.

Unfortunately, even with the best of intentions, when government bureaucrats and politicians try to design a horse, the result usually looks like a camel or, if we are very lucky, a zebra.

There are a number of good things in the ACA and there are many bad things. Instead of trying to improve the law, both sides have dug in their heels. The Democrats are blindly defending a program that is barely defensible. The Republicans are trying to repeal a program that probably cannot be repealed and are threatening to force a government shutdown.

Neither side can realistically expect victory, yet our elected jackasses are braying loudly, but not talking to each other. The deadline is looming, and along with it, mass confusion and a government shutdown. So much time has been spent in political posturing, rhetoric and filibustering that there is little time or appetite for meaningful negotiations.

That is a shame, because there is room for much compromise and for much improvement in the ACA. Most of the following are achievable and should be discussed:

• Permanent repeal of the sustainable growth rate formula and fair physician payment so Medicare and exchange patients have access to quality and timely health care by the most qualified practitioners in adequate networks.

• Eliminate the Independent Payment Advisory Board, which threatens rationing and access to care.

• Consider delaying the individual mandate or possibly the entire ACA.

• Meaningful medical liability reform will greatly reduce defensive medicine costs.

• Eliminate the medical device tax that will stifle innovation.

• Promote medical savings accounts as an option in exchanges.

These and many other issues can and should be considered and a compromise sought, so this disgraceful deadlock and brinkmanship is ended.

It is a pity that the jackasses that represent us are not responding to the “carrot” of good government. What stick shall we use on them – before we kick them all out of office?


Sam Unterricht, M.D., is president of the Medical Society of the State of New York.