Column #113

What are the unintended consequences of the Affordable Care Act (ACA)? Does it incentivize the obesity epidemic, the opioid crisis, higher healthcare costs, and more chronic disease? These are serious questions because chronic disease treatments are 85% of our nation’s healthcare costs.

The objective of ACA was to lower individual healthcare costs by subsidizing insurance premiums, spread the risks across more healthy people, and lower per capita demand for healthcare by increasing preventative care. But the results don’t support those goals. That’s because people react to their environments and, since money is a big motivator, the incentives and penalties provide inappropriate motivation.

It’s indisputable that money and power heightens basic ethical tendencies. This is true for all aspects of life. An honest person will tend to stay that way. A dishonest one will cheat when able.

Many medical doctors are motivated by wealth, some for good while others cut corners. The dishonest ones overprescribe tests, pills, and operations to earn more money. Some even overprescribe opioids for profit which is how most opioids get on the street and fuel today’s opioid crisis. Income driven doctors are not inclined to recommend alternative approaches to chronic diseases the same way veterinarians won’t recommend raw grass-fed meat for dogs and cats. They want their chronic disease customers coming back year after year.

The ACA does not permit insurance companies to mean test their customers or applicants. That eliminates the use of monetary incentives to encourage healthier lifestyles. A thin 30-year-old who follows The Real Diet of Man pays the same premium as an obese 30-year-old who lives on pizzas, cokes, and deserts. So there’s no incentive for obese clients to change their ways. The same goes for the addicted opioid user especially when drugs and medical visits are “free.”

When the healthcare system covers all risks and services, the resulting unlimited demand drives costs higher. Doctors have no competitive restraints on what they prescribe. The sick receive unlimited treatments, even those on their death beds. Subsidized insurance companies don’t care because profits are guaranteed.

The ACA was signed into law on March 23, 2010. According to the Centers for Disease Control  (CDC) the results are not pretty.

Per capita healthcare costs were $8,269 in 2010 and $10,345 in 2016, a 25% increase while the Consumer Price Index increased only 12%. In 2010, individual monthly insurance premiums were $159 with a $2,084 deductible. In early 2017 individual premiums were $393 with a deductible of $4,328.* Government subsidies, from taxes, make up the shortfall.

About 35% of all U.S. adults were considered obese in 2010. In 2016 it was nearly 40%. Young people (2-19 years of age) are following suit with 16.3% being obese in 2010 and 18.5% considered obese in 2015-2016. That’s a 14% jump in the obese population!

Opioid deaths were about 21,000 in 2010 and estimated to be 32,000 in 2016.

Incidences of chronic disease continue to increase year after year. When 40% of all adults are obese, I believe more than 95% of all adults must be contending with one or more chronic diseases–some which are minor while others are major.

Clearly, in the past seven years the ACA has not achieved its goals. And the disincentive it has created for people to take charge of their health by improving their lifestyles is especially worrisome. Instead of eating healthy foods, exercising, getting proper sleep, and avoiding drugs and excessive alcohol, everyone knows they will be “cured” no matter what. And they know that others who diligently avoid the carefree lifestyle pay the same premiums while not having near as much “fun.”

No wonder most Americans are on drugs!

To your health.

Ted Slanker

Ted Slanker has been reporting on the fundamentals of nutritional research in publications, television and radio appearances, and at conferences since 1999. He condenses complex studies into the basics required for health and well-being. His eBook, The Real Diet of Man, is available online.

For additional reading:

How Obamacare Fuels The Obesity Epidemic

Did Obamacare Make the Opioid Crisis Worse?

Prevalence of Obesity Among Adults and Youth: United States, 2015–2016 by CDC

Six Economic Benefits of the Affordable Care Act by Jason Furman, Chairman of the Council of Economic Advisers

Why Power Corrupts By Christopher Shea, Smithsonian Magazine

Per Capita Healthcare Costs from World Bank

The Supply of Prescription Opioids Remains High in the U.S. from CDC

from Fight Chronic Disease

Average Individual Health Insurance Premiums 2008 to 2017 from eHealthinsurance Services, Inc.

* In 2010, average family monthly insurance premiums were $392 with a $3,531 deductible. In early 2017 premiums were $1,021 with a deductible of $8,352.