The Supreme Court’s 7-to-2 decision Thursday upholding the Affordable Care Act seemingly puts a stake in the heart of Republicans’ decade-long effort to do away with Barack Obama’s signature health-care reform.

But this victory comes with a major asterisk: The battle to preserve the ACA doesn’t mark the end of Americans’ health-care struggles. The 2010 Affordable Care Act represented immense progress for our nation while simultaneously falling far short of addressing major problems in our disjointed health-care system. The battle to ensure that Americans can afford their medical bills and receive adequate treatment continues.

Let’s consider the context. The United States spends significantly more than any other country on medical care as a share of gross domestic product. Instead of these enormous sums ensuring access to excellent treatments for all, our country has such notable records as the highest maternal death rate among developed countries, while patients receive mountains of bills.

The typical deductible — the amount of money policyholders need to pay before their insurance will pay for almost anything — is more than $1,000 for both employer-based plans and those purchased on the ACA exchanges. Co-pays add more to annual health insurance expenditures. (Our health insurance system’s structure also costs people in less obvious ways. Linking insurance to employment likely drives salaries lower; large employers pay an estimated $15,000 per employee for health insurance.)

The U.S. health-care system is broken, but do other countries have it better? Seven leading health economists and public policy experts weigh in. (James Fox/The Washington Post)

Americans are billed every which way the medical industrial complex can think of, including having to pay hundreds of dollars out of pocket for the privilege of an ambulance in an emergency situation. Those concerned about the nation’s falling birthrate should consider that in 2015 women giving birth in the United States paid, on average, $4,500 out of pocket. In Finland, the cost is $60, and that includes the baby sleep box that new moms receive. Americans pay multitudes more for some of the same drugs compared with other countries’ costs, if we can access them at all — sadly, some Americans with diabetes die because they can’t afford insulin. Nor does staying in network always help with affordability. A Kaiser Family Foundation study this year found that about 1 in 6 in-network claims were initially denied by HealthCare.gov issuers.

Now, consider some of the impact of all these bills: Hospitals sue their former patients for payment; credit cards are offered up in doctor’s offices, urgent-care centers and hospital emergency rooms; 1 in 3 campaigns on GoFundMe seeks to help pay medical bills, its CEO said in 2019; and many cancer patients end up filing for bankruptcy.

No matter the circumstances, the rapacious medical industrial complex keeps a laser-like focus on profits. UnitedHealthcare recently announced that, once the covid-19 pandemic passes, it would begin conducting after-the-fact reviews of emergency room service and bill policyholders for visits that don’t meet its criteria for urgently needed care. (That suspected heart attack turned out to be heartburn? Good luck to you!) After a public outcry, the company said it would delay implementation.

How much help Americans can expect from Washington is still TBD. Late last year, after years of effort, Congress agreed on legislation banning many emergency room surprise bills. Covid relief legislation passed in March included increased subsidies to help Americans purchase insurance on the exchanges. Notably, this bill passed Congress via the reconciliation process, without a single Republican vote. But that aid is scheduled to last only through the end of 2022, with no guarantee of extension. President Biden ran on a promise to establish a public insurance option, but the White House is putting little muscle behind that idea.

On the legislative horizon, there’s a push to reduce the Medicare eligibility age from 65 to 60 (another Biden promise) and to get the program to pick up the cost of vision and dental services. These efforts are expected to be included in the infrastructure legislation that Democrats are prepping (and appear likely to try passing via reconciliation if efforts at bipartisanship fail). Should they materialize, these would be positive steps — but they would only start to scratch the surface.

What all this means is that the ACA and incremental reforms are not enough. They never were. The issue of how much we personally pay for medical care will continue to roil our politics till our elected representatives summon the courage to push back against the lobbying prowess of hospitals, insurers, Big Pharma and the private-equity giants investing in the health-care sphere. People in other first-world countries don’t have to think about barbaric financial bloodletting when they need to see a doctor. Neither should we.

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