On June 28, 2012, the US Supreme Court ruled that the Patient Protection and Affordable Care Act (ACA) is constitutional in a 5-4 decision. In a televised White House statement, US President Barack Obama said: "[W]hatever the politics, today's decision was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court's decision to uphold it." While discussion of the constitutionality of the ACA was extensively debated in the courts and validity of the provisions has hinged upon legal precedence, the perception of the general public is that very little was discussed with respect to how it would apply to the day-to-day medical care of patients. While the ACA is an altruistic attempt to reform health care, it is, in fact, just another incremental step in a series of health care reform measures in American history that have led to the current crisis in the US.
Proponents of the ACA quixotically hope that incremental expansion of health care and its provisions such as Medicaid and Medicare will translate into monumental benefits and comprehensive health care for all Americans. Opponents, on the other hand, have argued that the ACA barely puts a dent in resolving the health care crisis. In fact, there are incipient signs that certain ACA provisions, such as Medicare reimbursement cuts, may even be detrimental to the accessibility of health care. In order to address the current health care needs of Americans, a peer-to-peer network health care paradigm is needed to bridge the gap while the effects of the ACA provisions are systematically assessed.
The chain reaction-like scenario that led to the health care crisis goes as such: (1) uninsured persons consume health care; (2) some of these people fail to pay the full costs; (3) in turn the unpaid costs of that health care $43 billion in 2008 [PDF] are shifted to and spread among medical providers; (4) thereafter medical providers, by imposing higher charges, spread and shift the unpaid costs to private insurance companies; (5) then private insurance companies raise premiums for health policies and shift and spread the unpaid costs to already-insured persons; and (6) consequently already-insured persons suffer higher premiums. Additionally, some uninsured individuals decline coverage due to higher premiums.
The ACA legislation reveals its noble intent as it attempts to fund the health care model through major players such as the federal government, pharmaceutical companies and insurance industries, but the ACA provisions alone will not provide sufficient funds as the rate of increase of health care costs is exponential in a closed and unsustainable system. Other reformed entities are needed to work in concert with the ACA to achieve this end. A peer-to-peer network will lend extra support and serve as a buffering system or safety net for Americans while allowing time for the ACA provisions to take effect.
Health care accounts for approximately 16 percent of the US gross domestic product of $14.5 trillion in 2010 the highest among the world's industrialized nations. Over the past decade the pace of total health care spending has grown faster than both inflation and the growth in national income. The traditional model of health care was fee-for-service where a physician seeks payment from a patient for health care services rendered. Through the evolution of health care reform from the traditional-fee-for service to health management organizations (HMOs), Medicare and Medicaid has attempted to curtail escalating medical costs and these government programs account for a significant share of health care spending. Their share, however, has increased at a slower rate than private insurance companies, which have experienced a dramatic increase in spending over the past two decades. At the same time, consumers have seen their out-of-pocket costs for deductibles, co-payments and other expenses rise significantly throughout the same period. The growth in costs has raised many questions including: what factors drive the rise in costs, how to best curb cost increases and whether higher spending has resulted in commensurate delivery of care.
The ACA is a culmination of the realization that health care coverage needs to be further expanded from existing health care paradigms. However, it may not necessarily address the health care crisis that Americans face today. Approximately 50 million Americans are uninsured. The congressional findings state that some individuals make an economic decision to forego health insurance coverage and attempt to self-insure, which increases financial risks to households and medical providers. Proponents and critics of the ACA abound but few can offer a model that has been proven to work.
A paradigm shift is needed to break this vicious cycle of escalating costs and down-spiraling access to quality care. This is where peer-to-peer networks come in. Such a network is premised on an Internet peer-to-peer, question-and-answer system where users can lend their health care knowledge and expertise to mitigate the health care crisis. Users are able to rate information and responses they find useful, relevant and applicable to their personal health needs. A highly rated user would achieve a recognized status of "grandmaster" or "master" whereas a less helpful user would be rated as "amateur" in the peer-to-peer community. This rating system would signal to other users what information can be relied upon and would be applicable to them.
The timing of implementation of this peer-to-peer paradigm in health care is ripe. Eight out of ten internet users look to online resources for health information, making it the third most popular online pursuit among all those tracked by the Pew Internet Project. Interestingly, for individuals who have a serious chronic condition such as cancer, a majority of users want the information from the Internet only if it offers hope rather than facts. The peer-to-peer network market consists of individuals with chronic conditions as well as caregivers, the combination of which could serve as a good support base for the sick. The focus is primarily on patients with chronic illnesses because of the unique needs of this segment of the population. Patients dealing with a chronic disease, such as cancer, use the Internet to supplement information obtained from health professionals. The wide range of individuals encouraged to utilize a peer-to-peer network makes this health care service unique. As much as 80 percent [PDF] of users trust the internet to research medical information to care for themselves or their friends and family. A peer-to-peer network will provide much needed access to useful, relevant and applicable health care information. This expansion of access will undoubtedly have many benefits including, but not limited to, cutting costs, expanding care to rural and remote areas, freeing health care providers' time to address critical needs and providing peer-to-peer social support.
The US health care crisis is real and imminent, and the existing infrastructure will be unable to counter the exponential rising costs of health care and the demand for such care. While the Supreme Court's ruling on the constitutionality of the ACA is a step in the right direction, it is certainly not the magic bullet. A peer-to-peer network would be a low cost and effective way to provide immediate support to those who cannot wait for pending ACA legislation to take effect.
Dr. Tony Quang provided this insight through his experience as an assistant professor of radiation oncology at VA Puget Sound Health Care System & University of Washington Medical Center. He plans to complete his legal studies at the University of Washington in 2013.
Suggested citation: Dr. Tony Quang, A Peer-to-Peer Network: Bridging the Health Care Gap, JURIST - Dateline, Oct. 17, 2012, http://jurist.org/dateline/2012/10/tony-quang-health-care.php.
This article was prepared for publication by Emily Osgood, an associate editor for JURIST's student commentary service. Please direct any questions or comments to her at firstname.lastname@example.org