Find real health care reform: demand adaptation and innovation.

• Author: Loudon, Greg
• Position: HEALTH & MEDICINE: OP-ED

The Patient Protection and Affordable Care Act (PPACA) of 2010, also known as health care reform, is receiving mixed reviews from both advocates and opponents of the bill. Some provisions have proven difficult to implement and regulators are slowly rolling out guidance. As health plans have their first renewals following Sept. 23, 2010, we are seeing the removal of lifetime maximums, and the phase-out of annual maximums. The law eliminates pre-existing condition exclusions for children under age 19. Children can now stay covered to age 26, and new plans are paying for expanded preventive care.

By early February 2011, rulings were released in four federal court cases on different lawsuits brought against the federal government challenging the constitutionality of the PPACA. Two of the cases were decided in favor of the federal government, and two have ruled that the individual mandate--the requirement that everyone in the country purchase insurance--is unconstitutional. The State of Alaska joined Florida and 25 other states in a suit in Federal District Court challenging the individual mandate as a violation of Congress' Commerce Clause powers. U.S. District Judge Roger Vinson ruled that not only was the individual mandate unconstitutional, but because the PPACA lacks a severance clause, the entire law must be thrown out. From a practical standpoint, Vinson is correct. With no individual mandate, then the entire bill is in jeopardy. All of the popular provisions within PPACA cost money. In 2014, pre-existing condition limitations will be eliminated for everyone, not just children. We can only afford this if everyone is included in the insurance pool. If you are allowed to wait to purchase health coverage until you need it without any penalty, most rational people will wait until they are sick--driving up costs for everyone else.

Regardless of one's opinion on the specifics of the PPACA, the necessity of reforming our health care industry is paramount. Our current spending on health care is unsustainable.

The U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) reports the following data regarding U.S. spending on health services.

This steady increase in health care spending limits employers' ability to invest in other areas and may threaten their viability. More businesses face the difficult decision to sacrifice the quality of health coverage provided to their employees, or eliminate it altogether...