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Impacts of Affordable Care Act coming

Retired Albany doctor gives insight into Affordable Care Act and health care costs

George Chastain, a retired anesthesiologist, spoke to the Dougherty Rotary Club this week regarding the Affordable Care Act. (Staff Photo: Jennifer Parks)

George Chastain, a retired anesthesiologist, spoke to the Dougherty Rotary Club this week regarding the Affordable Care Act. (Staff Photo: Jennifer Parks)

ALBANY — Down the line, there may be more of a sticker shock associated with the cost of health care as the Affordable Care Act begins to become more heavily implemented, a retired doctor told to an Albany civic club this week.

Dr. George Chastain, a retired anesthesiologist and a former chief medical officer at Phoebe Putney Memorial Hospital, spoke to the Dougherty Rotary Club about the health care law and how it relates to the costs of medical care.

The core of the law, he said, is insurance reform. This year is a pivotal one in terms of its increased impact on the general public — and one in which it will also get really visible, he said. The true cost of health care is virtually invisible and that increased responsibility for the cost is a new game, Chastain said.

“A new platform has to be put into place,” he said.

To provide perspective, Chastain offered some history of health care coverage as far back as World War II, when benefit packages were brought into play as an incentive for people to work.

“(People) were divorced, if you will, from the cost of health care,” he said.

In the mid-1960s, Medicare and Medicaid began providing a standard of care in a lot of different ways. Over time, the cost of delivering health care increased, more people entered the system and advances in medicine kept people living longer.

“It will split to the point that health care will become the most expensive thing we have,” he said.

He compared the underlying problem to people continuing to come back for food after they have been offered free steak.

“Over and over again, we are creating people who don’t know what health care costs,” the retired doctor said.

While giving a historical perspective, Chastain also mentioned the Children’s Health Insurance Program (CHIP) that was brought onboard in 1997, as well as the Emergency Medical Treatment and Labor Act that went into effect in 1986.

To that end, he gave some insight as to how an emergency room works, which will often take someone with a stomach ache in the event it could be a bad appendix because there is not often a clear definition of what constitutes a life-threatening situation.

“What it (an emergency room) is designed by law to do is to not take emergencies, but an emergent medical condition,” he said. “We are adding more and more people, not understanding (how much) it takes to take care of people because they don’t have to.”

The ultimate consequence is the creation of overindulged consumers with high expectations. “With rise in expectations comes a rise in cost,” Chastain said.

Chastain also made note of the so-called “good old days” before the Affordable Care Act. While those times seem attractive to some, he pointed out that those also were times in which people were falling off “the insurance cliff” — causing many to go into a state of financial instability.

“The good old days were not as great as (people think),” he said.

The law also includes the implementation of an independent payment advisory board, consisting of 15 members whose goal is to help reduce the cost of Medicare. For the most part, the board can act on something without congressional approval.

“These are 15 people, who in my opinion, don’t know much about rural health care,” Chastain said.

What patients expect from their health care these days is for it to be effective, defect-free, appropriate, compassionate and patient-centered. Things such as advancements in technology, prevention, productivity, quality waste and end-of-life care have led to cost increases. That, in turn, has led those in the health care industry to evaluate what preventive measures are necessary, what tasks can be done in fewer steps and properly investing in health care when it is needed most, he said.

The good news is that the system, and a time in which patients are becoming more informed, is understood better.

“Physicians are beginning to understand this,” Chastain said. “Go on Healthgrades sometime. Is it accurate all the time? No, but it’s a start.”

With the current president slated to be in office until the early part of 2017, and with many of the major parts being popular, with the exception of the individual mandate, Chastain said there is not an end in sight for the Affordable Care Act. What needs to change, he said, is an unorganized latent majority interest, silence of those in the profession, ambivalence about federalism and ambivalence about the poor.

From the acceptance standpoint, Chastain made reference to the 40-year journey Moses took to get Israel to the Land of Canaan even though they had gotten out of Egypt in a day.

“It took 24 hours for Moses to get the people out of Egypt, but it took 40 years to get Egypt out of the people,” he said while closing out his presentation. “The end is not in sight. We still have a lot to do.”