As the Supreme Court deliberates the Affordable Care Act, Americans should take a closer look at the commonsense reforms embedded in the law, including those that strengthen public health. Fixation on the law’s individual mandate has overlooked the law’s very important benefits for public health.
Lost amid the rhetoric about individual liberty is the public interest and common good of protecting all Americans from the costly and deadly menace of preventable infections.
Some wildly popular protections in the law, such as keeping children up to 26 on parents’ policies, barring insurance cutoffs for the sick, and ending co-pays for preventive care, have begun to gain the appreciation they deserve. But press coverage of how the law broadens the healthcare risk pool in order to lower overall costs — the so-called individual mandate — has disregarded the law’s focus on a responsibility all Americans share and have a stake in: stopping epidemics and fighting disease.
Foes of the law have failed to spell out how they would solve the public health challenges that the law tackles head-on. The federal law contains important tools for frontline providers to fight epidemics and face accountability. It also arms consumers with information to make decisions about where we seek care and how to avoid common infections.
One rampant form of infection, Clostridium difficile, or C. diff, results in more than 25,000 deaths each year and costs our healthcare system billions. Two years ago this month, my mother Peggy Lillis, an otherwise healthy kindergarten teacher in Brooklyn, N.Y., came down with what she believed was a stomach flu. Having never heard of C. diff, she assumed she picked up a bug from a student and didn’t fret. Six days later she was dead from toxic megacolon, the result of a virulent C. diff infection (CDI).
Irregular disclosure standards by healthcare providers and uneven state reporting and enforcement rules have made the number of infections and deaths like my mom’s hard to measure. Even in cases where it kills, C. diff often still doesn’t get cited on death certificates.
Against this backdrop, the Affordable Care Act contains strong incentives to measure uniformly, report, and counteract the public health crisis of C. diff and other healthcare associated infections. Building on previous reporting mandates from the Centers for Medicare & Medicaid Services, the Affordable Care Act creates a uniform online reference for the public to check the prevalence of healthcare associated infections at local hospitals and make our healthcare decisions accordingly. This tool alone is a significant advance.
The law also reflects sound logic and a basic sense of fair play in considering rates of infections in reimbursement rates to healthcare providers. By tying federal dollars to low incidence of healthcare acquired infections, the Affordable Care Act finally places the economic incentives where they belong.
I doubt most Americans realize that the very healthcare facility where your grandmother might contract C. diff or a multi-drug resistant staph infection (MRSA) can also charge Medicare for the treatment set in motion by their lax hygiene standards. The average cost to treat such an infection is nearly $14,000. Imagine bringing your car to a mechanic for a brake repair, only to have the transmission damaged, and get charged for both.
Such outrages have an overdue cure in the policy its critics label “Obamacare.” The Affordable Care Act, once fully implemented, would replace a status quo where economic incentives regarding healthcare associated infections are fatally misaligned with one driven by patient safety and accountability.
The stakes for our shared public health are much greater than any partisan bickering. Healthcare associated infections like C. diff are a growing threat to American lives and the economic stability of our healthcare system. Striking down or repealing the Affordable Care Act would put at grave risk the gains prompted by the law in reporting, tracking, and combating the epidemic of infections.
Even if they resist the opportunity presented by the Affordable Care Act to expand coverage to more Americans, or reject its individual mandate, opponents of the law cannot escape their own interest in a strong health system that mobilizes every available resource, including an informed populace, to combat epidemics.
Calls for scrapping the law in the political arena, or banter about broccoli in debate about its fate, ignore the focus on public health and saving lives reflected in the law. Especially in the absence of a concrete and comprehensive plan to replace it, losing the Affordable Care Act would reverse major progress in the fight to prevent disease. All Americans–candidate or voter, youth or senior–share an obligation to the hundreds of loved ones like my mother who suffer or die each year from C. diff to accurately track, measure, and combat this public health crisis to the fullest and best of our ability.
Christian John Lillis is co-founder and director, The Peggy Lillis Memorial Foundation, the first national organization dedicated to reducing and eradicating Clostridium difficile infections, or CDIs, through education and advocacy.
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