Effects and limits of ACA explored at NHBR Health Care Forum

Dr. Aaron Carroll didn't exactly provide the most reassuring words to the hundreds of people attending the fourth annual NHBR Health Care Forum, who were there to learn more about how the Affordable Care Act will affect their business.

Instead, Carroll came out swinging at the forum, which was presented by MVP Health Care and held at the Grappone Conference Center in Concord.

Carroll, a pediatrician, professor and author who has explained the health care system to Americans through his CNN blog and as a guest on a host of TV shows, took on just about every truism held by health care policy wonks on both the left and right about the nation's health care system and health care reform.

Carroll debunked the idea that the ACA could improve cost, quality and access at the same time. Those chanting the mantra "cheaper, better, faster" were simply wrong, he said.

"You can't do all these things at the same time," he said.

The United States has such an "irrational" health care system that, given its wealth, it manages to rank lowest, or near lowest when it comes to all three categories, as measured against developed countries around the world.

When it comes to access, he said, almost every other developed nation in the world has universal coverage. Only three countries besides the United States do not — Chile, Turkey and Mexico.

Nevertheless, he said, while the ACA will probably reduce the number of uninsured from about 50 million to 15 million, many of those remaining 15 million will pay a penalty to stay out of the system, and later on pay for the privilege of seeking coverage when they are sick enough to really need it.

Even adding millions of paying customers to the health care system won't stop rising costs.

In the United States, health care accounts for 17 percent of the nation's gross domestic product. It's a percentage that, compared to other countries, is "just off the charts — one-sixth of every dollar. That alone is unbelievable," said Carroll.

Given this amount of spending, the U.S. should have best quality in the world when it comes to providing health. But in the end — despite billions spent on CT scanners, MRI imaging and other high-priced technology and procedures — it has the fewest doctors, hospitals and hospital beds per capita among industrialized nations.

"We all hear about the long lines in other countries, but we all know how hard it is to get into see your doctor in the U.S.," said Carroll.

The United States, he said, has higher rates of lung cancer (despite lower smoking rates). It has high infant mortality rates, a higher maternal death rate during childbirth, and the overall death rate is lower than industrial countries.

Since the United States is spending so much more than other countries, and there is less access than other nations, that extra spending is all waste, he said.

Carroll said the most common fixes proposed for cost and quality, whether it's the ACA's mandates and accountable care organizations or tort reform laws and vouchers, won't have much of an effect on the overall cost of health care.

Providers working together — as they do in ACOs — might help cut some costs, but when providers control more of the market, "the pressure is to pay them more."As for tort reform, while necessary, it "does not save very much."Neither does block-granting Medicaid, he said. Or raising the eligibility age for Medicare, since it's cheaper to cover those in their late sixties under Medicare than at their workplace.

"You take the healthiest people out of the Medicare pool and you end up putting the sickest people in the private insurance pool," he said.While Carroll didn't specifically spell out what changes would work to improve cost, quality and access, he did allude to other countries that caused the United States to suffer by comparison. Only two, he said, had a strict government-run health care system. The others were some combination of public and private, with more government intervention.

"Government isn't good at innovation, but it does hold down costs," he said.

The Health Care Forum also included a panel of New Hampshire experts who discussed the ramifications of the ACA in New Hampshire.

The panelists were Charla Bizios Stephens, director of the Human Resources State Council of New Hampshire and litigation director at McLane, Graf, Raulerson & Middleton; Lucy Hodder, chair of the Health Care Practice Group at the Concord-based law firm of Rath, Young & Pignatelli; Frank G. McDougall, vice president of government affairs at Dartmouth-Hitchcock Medical Center; Don Pfundstein, an insurance and regulatory attorney and shareholder and director of the Concord-based law firm of Gallagher Callahan & Gartrell; and Rachel Rowe, executive director of the Granite Healthcare Network.

Taking questions from the audience, the panel explored the intricacies of the ACA and health care reform in general, and how it affects Granite State employers and their employees.

Other sponsors of the Health Care Forum were: Anthem; Harvard Pilgrim Health Care; NH Sportsplex/Executive Health & Sports Center; Gallagher, Callahan & Gartrell; Geneia, Northeast Delta Dental; The Scott Lawson Group; and ENH Power.