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MARCH / APRIL 2014 :: 75(2)
Medical Imaging

Medical imaging has revolutionized screening and diagnosis, but this technology is not risk-free. As use of advanced imaging has grown, attention has increasingly focused on the risks of radiation exposure, the anxiety associated with incidental findings, and the costs of such imaging. This issue of the NCMJ will address the pros and cons of medical imaging and will discuss how this technology can be used more safely and effectively.


The Affordable Care Act: Ethically Right for Our Wealthy Nation’s Health

Richard A. Dickey

N C Med J. 2014;75(2):151.PDF | TABLE OF CONTENTS

To the Editor—The November/December 2013 issue of the NCMJ included a Letter to the Editor titled “Health Care Costs Must Come Down” by Ron Howrigon [1], which I feel demands a response.

I heartily agree with Howrigon that health care costs must come down. This is inarguable, and the rate at which health care costs are rising has already been moderated since the Patient Protection and Affordable Care Act of 2010 (ACA) was passed—although costs may rise again as the ACA is fully implemented and coverage is extended to millions of uninsured individuals. However, Howrigon totally avoided discussion of the ethical and moral issues the ACA sought to address, particularly the American public’s right to good health care. As members of a wealthy nation, it is our obligation to provide that coverage, and the ACA attempts to do so.

As a consultant to physicians, Howrigon is not a disinterested party in the health care system. He admits his biggest concern is that the ACA “will try to control costs by drastically reducing reimbursement to physicians.” He (and we) must realize that our health care system is rapidly evolving and will not be nearly as dependent on physicians in the future as it was in the past. When the ACA was being considered by Congress, this law was read and studied carefully by those whose corporate bottom lines might be significantly impacted by it, and by the lobbyists who represented those interests. I too read it—all of it.

As I discussed the ACA with others who had not read it, I shared my excitement about how much of the law was directed toward finding ways to assess and improve cost effective medical care and coverage. I believe these aspects of the ACA were included with the expectation that, someday, the findings of this research would be used to improve health care and to save money through the implementation of evidence-based practices and payment policies identified by that research. I am aware of the considerable compromises our elected officials in Washington, including our President, had to accept to get the ACA through Congress. I hope that, over time, the positive effects and benefits of the ACA—such as the coverage of nearly 50 million uninsured Americans and the removal of pre-existing condition clauses—will be appreciated by most Americans. While I am dismayed by the unrelenting efforts in Congress to undo or limit funding for the ACA, the deficiencies of which are remediable, I remain excited about the good things which have already come—and will continue to come—from this legislation, which I believe is one of the most courageous, morally right steps our nation has ever taken.

Potential conflicts of interest. R.A.D. has no relevant conflicts of interest.

1. Howrigon R. Health care costs must come down. N C Med J. 2013;74(6):551.

Richard A. Dickey, MD, FACP, FACE retired endocrinologist, Hickory, North Carolina.

Address correspondence to Dr. Richard A. Dickey, 51 Players Ridge Rd, Hickory, NC 28601 (