Now that the U.S. Supreme Court has cleared a legal path for full implementation of the Affordable Care Act, the battle over the controversial health reform law will shift to the next presidential campaign, where Republican candidates will likely call for its repeal and Democrats will vow to keep it in place.
That fight will be loud and, at times, shrill. But it shouldn’t distract us from a simple fact: the importance of the law widely known as Obamacare has been exaggerated by all sides.
The ACA is not about health, or even about health care. It’s mostly about insurance, or how the money we pay to doctors, labs, hospitals and drug companies should be collected and distributed.
That’s a big deal for the medical industrial complex. And in our system, it is certainly better to have insurance. It can keep you from being saddled with bills you can’t pay if you get really sick or run over by a bus.
But insurance does not equal heath care, and health care does not guarantee good health. So restructuring the insurance industry, while a huge undertaking, won’t make people healthy or keep them that way. That task relies on the actions of millions of Americans in their homes, communities and workplaces.
Much of our health is shaped by where we live, where we work, what we eat and how much we exercise. And all of these things tend to be connected. Our genetic profiles – the hand we were dealt at birth – complement the other factors.
The biggest single health problem and cause of death in America today is heart disease, accounting for more than one in four deaths each year in California. Some of this is due to genetics, and some to the fact that we are living longer, and the longer we live the more likely our hearts are to give out. But much of the heart disease prevalent in younger people can be prevented with healthier lifestyles.
Another common killer is diabetes. About 4 million California adults have diabetes, and the numbers are rising. Nearly one-third of hospital stays among Californians 35 and older involve diabetes. The total cost of the disease – including health care, disability payments and time lost from work – is probably more than $25 billion a year.
Yet this disease is largely preventable. A major federal study of 3,000 people at high risk for Type 2 diabetes found that losing about 7 percent of body weight and exercising 30 minutes a day, five days a week could reduce a person’s likelihood of getting diabetes by 58 percent.
But fighting these diseases is about more than just telling people to eat better and exercise more. Too many people live or work in conditions that make healthy living difficult. When you are struggling every day just to survive, or to house and feed your family, a healthy diet and exercise can be a luxury.
The Affordable Care Act does include measures to prevent disease, including new mandates requiring health insurance to cover annual checkups and tests. The law also provides grants to employers to improve wellness in the workplace and money for communities to try to change conditions that make healthy living difficult.
But while the authors of the ACA sought to elevate prevention to a national priority, that goal has been overwhelmed by the bitter, unending political controversy over the law’s insurance provisions.
The real debate the candidates for president should be having is not about how to pay for health care after people get sick. It should be about how best to keep people healthy in the first place.
Daniel Weintraub is editor of the California Health Report.