The Affordable Care Act – Can America Afford it?

From Joseph M. Valenzano Jr., Founder and CEO, Exceptional Parent


“In the end, more than freedom, they wanted security. They wanted a comfortable life, and they lost it all – security, comfort, and freedom. When the Athenians finally wanted not to give to society but for society to give to them, when the freedom they wished for most was freedom from responsibility, then Athens ceased to be free and was never free again.”

Edward Gibbon  from the History of the Rise and Decline of the Roman Empire, circa 1796

Perhaps, arguably one of the more controversial and far-reaching decisions of our lifetime has been the recent Supreme Court Ruling affirming the Affordable Care Act, the signature legislation of President Obama’s Administration as Constitutional in part.  But this commentary will have nothing to say about this decision nor the political opinions expressed on both sides of the aisle.  Frankly, there has been far too much of this debate which has polarized our nation and I have no intention of attempting to deal with these issues.  What I want to focus on are the serious questions raised by this new law; how we will as a nation be able to pay for it; how this will improve the quality of care we receive as citizens and how this will stimulate innovation and research in the development of new treatment therapies, drugs and surgical interventions.   Much of this has been given short shrift in the media.  At the end of the day, the economics of this Act will ultimately hold out for all Americans just how much better or worse we will all be as a result of this new initiative.

Let’s talk about costs for a moment. Early on, estimates from the Congressional Budget Office (CBO) suggested that from 2013 through 2022, the costs of the Affordable Care Act come to $1.76 trillion — almost twice the original estimate. Recently, these estimates were lowered to $1.16 trillion.  It gets worse. Annual gross costs after 2021 are more than a quarter of $1 trillion every year — for the foreseeable future. This new entitlement comes in a country already drowning in $16 trillion of debt and a nation who has spent roughly $2 trillion more than it has taken from revenues.  We call that “deficit spending”.   Let me explain the national debt and why it is a problem.


  • U.S. NET TAX REVENUE-ALL SOURCES:              $2,170,000,000,000
  • FEDERAL BUDGET SPENDING:                              $3,820,000,000,000
  • DEFICIT                                                                     $1,650,000,000,000
  • NATIONAL DEBT BEGINNING OF YEAR               $14,271,000,000,000
  • DEFICIT FINANCING-“NEW BORROWING”:       $1,650,000,000,000
  • NEW NATIONAL DEBT                                           $15,921,000,000,000

Now, let’s convert all of these numbers to a typical American family in order to understand the full impact of what has been going on. To do that we need to eliminate a whole bunch of zeros:

  • TYPICAL ANNUAL FAMILY INCOME:                    $21,700
  • MONEY THE FAMILY SPENT                                  $38,200
  • NEW DEBT ON “CREDIT CARD”                            $16,500
  • ADD NEW DEBT ON CARD                                     $16,500
  • NEW CREDIT CARD DEBT                                       $159,210

Note:  When the “Super Budget Committee” met last Fall with the mandate to “cut spending”, they were able to cut $38,500,000,000 from the Federal Spending Budget.

When this was announced it sounded like it was a lot of money.  But if you strip away the zeros and convert it to a typical family, what was cut from the money the family spent was $385 out of a total spending of $38,200.  How long do you think this can go on for the family?  How long do you think it can go on for our nation?  At some point, the nations of the world will say “no more borrowing”  and thinking even further into the future, they will say “the dollar is so weak we can no longer tie our faith in it so you can print all you want America but we are going to base value on a “basket” of other currencies”.  If you think this cannot happen, think again.  There is already a movement to do just that among the less friendly nations of the world.

Our nation is faced with an incredible spending problem which will only get worse with the Affordable Care Act.  One glaring reason is: we will add some thirty million more people who will suddenly have health care coverage but who cannot pay for it.  Where will we get the physicians, nurses, allied health care professionals to deal with these people and how will such care be funded?  The answers are: we don’t know and from the way we have always funded it before…on the backs of those people making money and paying taxes. They will shoulder this burden by paying more taxes and working on behalf of those who cannot or will not.

The American people, by an astonishing two-thirds majority, wanted the law and/or the individual mandate tossed out by the court. They only got part of their wish. But here is an important question: If the federal government can compel a private citizen, under threat of a federally imposed penalty (or tax or whatever you wish to call it), to engage in a private contract with a private entity (to buy health insurance), is there anything the federal government cannot compel the citizen to do? How is this not an infringement on individual freedom?

The fact that the Affordable Care Act was upheld in part by the SCOTUS fundamentally changes the nature of the American social contract. It suggests the effective end of a government of enumerated powers — i.e., finite, delineated powers beyond which the government may not go, beyond which lays the free realm of the people and their voluntary institutions. The new post-Affordable Care Act contemplates a central government of unlimited power from which citizen and civil society struggle to carve out and maintain spheres of autonomy….with a cost burden that only increase that which we face today.  It begs the question of how we will be able to afford it without massive tax increases and drastic cuts in spending….including things like Social Security.  Then there is the question of how quality health care can be delivered to the millions more who will suddenly be covered from a health insurance perspective because nowhere in the Affordable Care Act is there a provision or even an incentive for training and educating more physicians.  Who then will deliver quality care?  And while I recognize that 16,000 additional Internal Revenue Agents will be hired to insure that the provisions of the Act are enforced, how does this increase quality health care?  The last time I looked, IRS agents were not trained, skilled or even remotely competent in the recognition, diagnosis and treatment of disease.

Let’s talk now about Contraception.

The recently issued regulation on contraceptive coverage has allowed us to see exactly how this new power works. All institutions — exempting only churches, but not exempting church-run charities, hospitals, etc. — will be required to offer health care that must include free contraception, sterilization and drugs that cause abortion.   Seems to me like a direct hit on religious freedom.

Consider the cascade of arbitrary bureaucratic decisions that resulted in this edict:

(1) Contraception, sterilization and abortion pills are now suddenly classified as medical prevention.  Really?  Who determined this and on whose authority?  The Secretary of Health and Human Services, invoking the Institute of Medicine. But surely categorizing pregnancy as a disease equivalent is a value decision disguised as science. If contraception is prevention, what are fertility clinics? Disease inducers? And if contraception is prevention because it lessens morbidity and saves money, by that logic, mass sterilization would be the greatest boon to public health since the pasteurization of milk.

(2) This type of prevention is free — no co-pay. Why? Is contraception morally superior to or more socially vital…and more of a “right” than — penicillin for a child with pneumonia?

3) “Religious” exemptions to this edict extend only to churches, places where the faithful worship God, and not to church-run hospitals and charities, places where the faithful do God’s work. Who promulgated this definition, so stunningly ignorant of the very idea of religious vocation? Why the Secretary of HHS of course!  How does this add to quality of care?  What does it have to do with that? Today, it’s the Catholic Church whose free-exercise powers are under assault from this cascade of dictums sanctioned by — indeed required by — the Affordable Care Act. Tomorrow it will be the turn of other institutions of civil society that dare stand between the unfettered power of the government and the rights of the individual citizen.

And what of our Physicians, the best trained and educated physicians on earth?

Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama’s health care reform law, according to a survey released by the Doctor Patient Medical Association.  The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation, which was upheld last month by the Supreme Court.

Even if doctors do not quit their jobs over the ruling, America will face a shortage of at least 90,000 doctors by 2020. The new health care law increases demand for physicians by expanding insurance coverage. This change will exacerbate the current shortage as more Americans live past 65. By 2025 the shortage will balloon to over 130,000, Len Marquez, the director of government relations at the American Association of Medical Colleges, told The Daily Caller.  But it does not end there.  Because of the remarkable strides we have made in interventions for complex disorders and disabilities, especially for the newborn, more children born with disabling conditions are living longer, more productive lives.  Can that be sustained in a health care climate where increased costs to cover millions of people who are not even citizens of our country drain our precious resources.

“One of our primary concerns is that you’ve got an aging physician workforce and you have these new beneficiaries — these newly insured people — coming through the system,” he said. “There will be strains and there will be physician shortages.” The DPMA found that many doctors do not believe the Patient Protection and Affordable Care Act will lead to better access to medical care for the majority of Americans, co-founder of the DPMA Kathryn Serkes told The DC.

“Doctors clearly understand what Washington does not — that a piece of paper that says you are ‘covered’ by insurance or ‘enrolled’ in Medicare or Medicaid does not translate to actual medical care when doctors can’t afford to see patients at the lowball payments, and patients have to jump through government and insurance company bureaucratic hoops,” she said

And the impact on Medical Research?

In a nation floundering in debt, how will there be enough incentive to continue on with research and development, in finding new treatment therapies for cancer and diabetes, for quality care to help those with developmental disabilities and those with disabilities and chronic lifelong disorders.  It is no secret that the United States has earned more Nobel Prizes in Medicine and Research than any other nation on earth.  Can we continue that pace?  I believe we must……but funding will be difficult to come by.


We live in the greatest nation on earth.  No other nation has more compassion and commitment to help those in need than the United States of America.  Is our existing health care system perfect?  No, it is not.  Does it require immediate and wholesale change?  I do not believe so.  We have problems but more of our problems are manmade, therefore they can be fixed by men.  But to take on sweeping change for something that is working, in a period of time when we are spending way too much than we take in, is a blueprint for disaster.  And, if you are at all like me you will objectively evaluate the current situation and conclude:

  • The U.S. Post Office is Broke.  That is a government run institution;
  • The Department of Energy has yet to demonstrate a single success but is spending far more than ever envisioned…and that is a government run entity
  • We have a litany of continued problems in our banking system, overseen by the Federal Government
  • Government forays into the investment banking field like Solyndra, etc have proven once again ineffectual and disastrous.

…..and the list goes on

Are you comfortable thinking that the Government can run our Health Care System?  I have some questions.


2 Responses to “The Affordable Care Act – Can America Afford it?”

  1. Prof. Valenzano’s essay on the AHCA cuts through the morass in clear language we can all understand. He covers the implications the Act will have when the federal government goes beyond its enumerated powers as defined by the US Constitution. A superficial, fast review of the COnstitution will show that our Founding Fathers purposely deliniated what the powers of the central government were. And a simple glance will clearly reveal that the federal government is legally forbidden to go beyond its enumerated powers! These powers are listed and the list is very short. Get a copy of the US Constitution and read them yourself. No law degree nor college degree necessary to read and understand these. Most of these powers are left to the states of the Union. Beyond the constitutional reasons and the power grab by the fedral government, as evidenced by this new health care act, the economics are overwhelming against carrying it out as discussed by Joe Valanzano. The impracticality of implementing the Act is also self-destructive for our system of health today. The intrusion of the federal government forcing Americans to buy this insurance or be penalized is beyond reason and legal precedent as already mentioned when we read the limited enumerated powers listed in the Constitution. It ignores that the health care system will be stretched beyond is ability to cover Americans when it is extended to cover illegal immigrants, a figure so large that we can only speak of its in terms of tens of millions of illegals already here. No one and no agency, federal or state run agency has the exact number of illegal immigrants within the borders of the contiguous United States.
    Joe Valenzano knows from whence he speaks. He has been publishing in the health care field for many, many years. His accomplishments on behalf of the disabled and those with special needs are by any measure overwhelming in scope and a badge of honor that few Americans can claim.
    He has my vote for a place in any future committee dealing with health issues, the economy and even a place at Home Land Security in any future administration.

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