The HCR Frankenstein vs Zombie -- Which Monster Wins?

William T. Basco, Jr., MD; Robert W. Morrow, MD; Charles P. Vega, MD

Disclosures

November 09, 2010

In This Article

The ACA as Frankenstein's Monster -- Still Better Than a Zombie

Editor's Note: In light of the recent election, Medscape asked some of its Primary Care Advisors for their thoughts on how the results of the election might affect healthcare reform. The following is the first response from Charles P. Vega, MD.

Charles P. Vega, MD

I stared hard at this creature I had spent two years forming. Once, I had considered this a beautiful piece of work -- the result of my life's dream, but now it filled me with horror and disgust!
Frankenstein
, by Mary Shelley

It is fair to wonder whether the architects of the Affordable Care Act (ACA) feel a little like Dr. Frankenstein following the creation of his creature. Like him, they were considered mad for attempting the impossible -- the reanimation of true American healthcare reform. Like Dr. Frankenstein, they had to make severe compromises along the way. Dr. Frankenstein may have had to pull a liver from this corpse or an elbow from that one, whereas President Obama's healthcare team had to cajole and placate the medical insurance industry, the pharmaceutical industry, and physicians' interest groups.

In both the case of Dr. Frankenstein and the Obama healthcare team, the end result was far from what the creator had intended, and both creatures were certainly flawed. Unfortunately, Dr. Frankenstein never had another chance to improve his creation. That's too bad, because he might have signed some highly lucrative medical device contracts. He could have even have developed his own television program.

What became clear on November 3 is that many townspeople in the United States are not happy with the ACA, and they were out again with their pitchforks and torches calling for its demise. They do not want to go back to their village -- the one with 45 million people uninsured and ranked right next to Slovenia in terms of overall health systems -- until they are satisfied.

A kill shot to the ACA does not seem possible. A more likely scenario is an entrenched resistance to the elements of the program that remain under development, and those elements, including the establishment of insurance exchanges with a mandate for health insurance for all US citizens, are its most critical elements in promoting greater access to healthcare.

Many reformers hoped that the ACA would be the first step toward a more fundamental change in the US healthcare system. Sure, the creature may be flawed now, but maybe we can add a piece later that better controls healthcare costs -- then something that promotes higher quality of care. All the while, the percentage of Americans with health insurance would grow. Experience and an unwavering commitment to the need for change in the healthcare system would guide these decisions.

However, those changes depend on some intact form of the ACA. Take away parts of the package, and it will not have a chance to thrive. ACA has the potential to turn into a force for good that transforms the way in which Americans experience health. However, removing its brain or its heart turns it into another monster altogether: a zombie. Zombies do not have a strong track record when it comes to the welfare of the living. They mostly wander around without much of a plan at all.

Moving forward, we need to ensure that Dr. Frankenstein's monster does not transform into the zombie. The future of the village depends on it.

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