As the old adage goes, nothing in this life is ever free. This is especially relevant today, in light of the Supreme Court decision to uphold the individual mandate of PPACA. Now Americans everywhere will be required to purchase insurance or be faced with a penalty tax. The dissenting judges put it very clearly in their argument released this morning: “If the [insurance] industry does not respond by increasing premiums, it is not likely to survive. And if the industry does increase premiums, then there is a serious risk that its products — insurance plans — will become economically undesirable for many and prohibitively expensive for the rest.” In short, President Obama’s massive healthcare overhaul will no doubt cost Americans more money.
There were three main arguments from the PPACA-supporting justices: the Commerce Clause, the Necessary and Proper Clause, and the tax argument. The first two of these were shot down, but the deciding factor was the tax dispute. Despite President Obama’s statement in September 2009 "For us to say that you've got to take a responsibility to get health insurance is absolutely not a tax increase," the court clearly sees things differently. Chief Justice Roberts was quoted in his majority opinion as saying “Although the payment will raise considerable revenue, it is plainly designed to expand health insurance coverage. But taxes that seek to influence conduct are nothing new. Some of our earliest federal taxes sought to deter the purchase of imported manufactured goods in order to foster the growth of domestic industry.” While it is evident that the American population needs to take more responsibility in all aspects of life, some people say that it is not fair to require everyone to carry insurance: that forcing someone to purchase a product is unconstitutional. Even if people should do something, it is not the government’s place to force them to do it, and they are overstepping their boundaries.
On the other side of the fence are those who want everyone to have the same access to healthcare. With the current system, where healthcare services are so incredibly expensive, the only way that would be possible would be for everyone to have insurance. Without insurance, people cannot afford to have the procedures and medical care they so often need. In the end, the court ruling was to uphold the individual requirement, not as a mandate for everyone to purchase or carry insurance, but as a tax for those who do not. Chief Justice Roberts states “We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions.” This means that, even if they do not agree with the Act, they cannot rule it unconstitutional simply because they do not like it.
Stepping outside of the debate about whether the individual mandate is constitutional, we must now look forward, to how this will affect our current healthcare system. There are several factors at play, but we will limit this discussion to what we feel are the two most important: Supply and Demand, and Accessibility.
We have already seen a decrease in the number of doctors and hospitals over the past several years. Some of this has been due to recession, while some of it is due to the change in Medicare payouts. But the overall trend for the past few years has been a reduction in the supply of medical care providers. Since this law is designed to increase the number of insured lives, it is inevitable that there will be an increase in utilization of medical care, or demand. When you combine these two elements, you end up with more demand than you have supply. What does this mean for the average American? Longer wait time for services and procedures, and less accessibility to quality medical care.
At first glance, this might seem to be merely an inconvenience, but when you study other countries who have this same problem (Canada and several European countries), you begin to see that this leads to many people neglecting the routine preventative care that is so important to staying healthy. Because of this, cancer and other serious conditions are not caught as early, and the result is a much more serious condition by the time the patient receives treatment. Even though insurance carriers are now required to cover these procedures at no cost to the insured, that does not mean that insureds will have adequate access to the care. Add that to the growing rate of diabetes, obesity, and cancer in our country and we have a very serious potential problem. There has to be a reasonable solution to this issue.
Something else that arises from the upholding of PPACA is the increase in charges to privately insured or uninsured Americans to offset the reduction in Medicare payments. So, not only do we have a reduction in access, we have an increase in cost. Taking all of these aspects into consideration, we see a clear solution to this issue: medical tourism.
Since the passing of PPACA in March 2010, the realm of medical tourism has been growing rapidly. Medical tourism is defined by the Medical Tourism Association as follows: “Medical tourism occurs when people who live in one country, state, region, or city travel to another country, state, region, or city to receive medical, dental, or surgical care for either better quality, better availability, better access, or better pricing." We break out medical tourism into two sectors: domestic and international. Domestic medical tourism would be travel that occurs within your home country. This would be travelling to another state, city, or region of the US that provides quicker access, a better price, or better quality of care. International medical tourism would be travelling to another country for these same purposes.
Domestic medical tourism, or medical travel, offers a reasonable solution for those who are ethnocentric and want to stay in their comfort zone. By shopping around to different areas of the country, a person can find the best combination of price, quality, and accessibility. But the savings is limited because all areas of the United States are governed by the same laws, and are facing the same issues.
When you look at international medical tourism, the same purposes for travel apply, but the difference in price is significantly larger. There is also the aspect of new, innovative procedures. Many countries have advancements in care that the U.S. is only now testing. Examples of this would be non-invasive surgeries using high-tech lasers and stem-cell transplants or other treatments that are deemed experimental in the U.S.
When thinking of medical travel on an individual scale, one might ask why? The cost of travel and hotel fair can eat up the savings for the procedure. In some instances, this could be true. In others, the overall savings is still significant. The other thought you might have is, what if the facility is not in my insurance network? This can also create a problem, especially if you are insured by a carrier whose network is limited to just your state. But when you turn your attention to a group benefit, everything starts to fall in place. Add on a medical travel network to the existing network already in place, and you solve the accessibility problem. Then, add in an incentive from the employer, and you have a no-brainer.
Here’s how it works: Once the employer has added this new network, agreements are already in place for the best cost by location and procedure. The cost is inclusive of travel and hotel expenses for the patient and one family member. Now, add in that incentive – let’s say the employer covers the deductible, coinsurance and copay costs for the patient, so that they have absolutely no out of pocket expenses. Now the employee gets the benefit of the best care at the best price (nothing for them) and in a timely manner, and the employer gets the benefit of reduced claims, healthier population, and a quicker return-to-work scenario.
Although PPACA may have created new challenges for all Americans, we believe that the simple solution is medical tourism, whether domestic or international. Everyone should take more responsibility in their health and healthcare, not only by getting preventative screenings, but also by being intelligent, informed consumers. Whether you are looking locally or internationally, shopping for the best prices and the best doctors should come naturally to Americans. We bargain every day for the price of cars, homes, and other goods. By being informed and making healthy decisions about our future, we can make the most out of the PPACA reform.