Healthcare is more than a pawn, it is a problem

On the heels of the Aurora shooting tragedy there has been a fundraising campaign to raise money for the uninsured victims, some who are facing significant healthcare costs. In a time of crisis, Americans tend to rally to help those in need. This happens on a routine basis in communities around the country where a child gets an unusual disease or cancer and his or her parents are uninsured or woefully under insured. We witness campaign drives around golf tournaments, BBQ picnics, musical events, etc. that lift your spirits to help a child in need. Yet, we need to step back from this and see the bigger problem – these folks could not afford to be insured or had some form of limited insurance plan. This is a huge problem in America with over 45 million uninsured people of all shapes, sizes, colors, ages, religions and political affiliations.

The Affordable Care Act (ACA, which is referred derogatorily by naysayers as Obamacare) is an attempt to address this issue. After the first two years of its staggered implementation, we have added well over a million (I have seen 2 million used) young adults to coverage through staying on their parents’ plans, we have seen pre-existing condition restrictions for children go away, we have seen lifetime limits eliminated and we have seen preventive care opportunities increased. As I have said before ACA is not perfect and needs further tweaking before the majority of its roll out in 2014. I find it overly complex in many instances and it will be hard for the average Joe and Josephine to understand.

However, it has become a pawn in a political game. It has become a wedge issue that the GOP is hanging their hat on. Yet, the irony is the ACA is largely a Republican idea. Its roots spawned out of the Heritage Foundation and Senator Bob Dole posed a variation in the mid-1990’s as an alternative to the National Health Care Proposal recommended by the Clintons. I use the plural, as First Lady, now Secretary of State, Hillary Clinton was a huge, vocal proponent. Not surprisingly, opponents called it HillaryCare. Our legislators are not too original. While both measures failed, Governor Romney saw a variation of the ACA made total sense for Massachusetts. And, with much effort and politicking got the mandate requiring coverage passed. The MA Healthcare Law is working reasonably well. So well that Senator Jim DeMint recommended it in writing to President George Bush advocating the personal responsibility of the mandate. He was joined by other GOP senators as late as 2009.

However, this is not game. We have people in America who are dying because of lack of healthcare. They are not able to raise money like select few have done. For every golf tournament to raise funds for little Sarah, there a thousands of people who just die. Or, they get some indigent care, but their parents file for bankruptcy. Some readers may say that is sounding an undue alarm and that does not happen very often. According to The American Journal of Medicine in 2009 (as reported in an excellent piece in Readers Digest – “Why a Hospital Bill Costs What It Costs” in their September, 2012 edition):

– 62% of bankruptcies in the US are due to medical costs,

– there has been a 50% increase in the number of medical cost bankruptcies between 2001 and 2007,

– 75% of the people whose illnesses caused bankruptcy were insured (meaning under insured), and

– 38% of families with an illness had someone in the family lose or quit a job because of a medical event.

By getting more people insured be it through an employer’s plan, a healthcare exchange or Medicaid under ACA, people will have access to coverage when an event occurs, but also to garner preventive care services. If we are going to manage costs in any way, preventive care – wellness visits, screenings, mammograms, colonoscopies, etc. have to be part of the equation. No health care solution can solve our biggest driver of costs – we are a nation of overweight people who would rather medicate than exercise – but preventive care can help in that battle. Cancers detected early can be curable and not kill. Future train wrecks – which occur when someone hits his or her mid-forties and has not been taking care of his/ her health – can be avoided.

Plus, by having more people covered, the providers of healthcare are paid in a more upfront manner through a spreading of insurance risk. We pay for their coverage now, indirectly, through indigent costs. Insured individuals, direct users of the care and taxpayers pay for the uninsured and under insured through mark-ups on hospital services. If you get a chance to read the aforementioned Readers Digest article it will show evidence of the significant variability in costs. It will also show you other means of recouping costs through inflated incidentals. Key message – get an itemized bill for a hospital stay and shop around beforehand. This last point is key. Borrowing from Dwight D. Eisenhower, we have a “Healthcare Industrial Complex” in the US. There is so much money tied up in this business, and it is a business even if an entity is a non-profit, every measure will be undertaken to maintain profit margins. Unfortunately, some of these measures are not altruistic and the quality care is a lesser part of the equation.

This is the primary reason a national healthcare system cannot make it through. And, as someone who has worked closely with healthcare consultants in my career, a national healthcare system would be the better solution for us. It works too well in many other countries, yet the Healthcare Industrial Complex has done an excellent job of demonizing its consideration. The countries who have national healthcare kind of chuckle at the US and our healthcare troubles, but that seemingly is unimportant. But, national healthcare is not going to happen here. So, ACA was and is a reasonable compromise and will move us down the path of getting more people covered. Throwing it out the door would be poor stewardship on the part of the GOP should they carry the White House. And, the irony of all ironies, Governor Romney would be doing one of the greatest flip-flops known to man. He would overturn his greatest idea in public service.

Healthcare is not a pawn. There are many Americans needing the ACA to continue, including a great percentage of Republicans. When you look at the demographics of the GOP party and get out into the more rural regions of our country, there is a level of poverty that exists that is hard to believe it occurs in America. Rural healthcare is hemorrhaging. There is so much indigent care in rural hospitals (sometimes 2/3 of a hospital’s budget) that they cannot survive. The healthcare providers in these regions are much needed as key responders to the basic healthcare needs of a community. By covering more people, access to insured healthcare will be better for the patients and these and other hospitals. The GOP governors who are grandstanding saying we won’t accept the Federal Medicaid money need to go talk with their hospital and medical constituents. They will tell these governors this is a better path forward than the status quo.

So, the next time someone says they want ACA repealed ask them why. Many who say this don’t know why. They have been told that the ACA is a demon and must be defeated. That man over there passed this law and he must be defeated. Folks, this is not a pawn. People are dying and going bankrupt. The US is rated the most costly healthcare system in the world by the World Health Organization and the 38th in overall quality. I am all about Return on Investment. Under my calculations, that is a pretty crappy return. So, don’t let our healthcare be a pawn in some political game.

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32 thoughts on “Healthcare is more than a pawn, it is a problem

  1. As always, thorough and insightful. The key, as I see it, is our blindness to our own failures. As you note, “The US is rated the most costly healthcare system in the world by the World Health Organization and the 38th in overall quality.” It’s time to admit that need to clean up this mess and, as you say, stop treating health care as a political pawn. Well done.

      • This man deserves a much wider readership! It saddens me to see good blogs that are largely ignored while the ones about travel and food seem to be off the charts! Perhaps that says something about us as a culture!!??

      • You are both very kind and most helpful and appreciated ambassadors. I am not on social media and am in cognito, which are part of the issues, but I wish there was some greater interest in blogs on issues. Your two and several others (I don’t want to list as I am sure to leave someone off) are quite good. Jennifer does a great job of blending a wide range of material in an intellectual and entertaining way and being so inviting with her readers and I learn something new every time I read one of Hugh’s posts who has a broad and deep range of interests and understanding. That is why I am going back in time on both of yours. I take pride that the two of you pay attention to my blog when you have so much activity on yours. Thanks for your time and interest.

  2. Excellent post. I have asked a few “die hard” anti Obamacare people just what it is they object to, and the common response is their not wanting to be told what to do. Ask again, saying, well other than that what do you object to, and I’m usually met with blank stares or unintelligable mumblings.

    Our politicians on the red side of the aisle continue to maintain we have the best health care system in the world, and the anti ACA crowds seems to swallow this line, hook, line, and sinker. Ask again on their health care plans if they get laid off, then again we’re met with blank stares. I just can’t believe the stupidity of our people.

    Highest cost care in the world. Wonder what the recent HCA investigation into hundreds of unnecessary coronary procedures contributed to that? Or that our system is so wonderful, the nurse who was the whistle-blower was fired.

    And just a thought. Origionally the RepubliCANTS used Obamacare as a slur. Obama, in a brilliant political move, embraced the term as his own. Good for him.

    Good work

    • Thanks Barney. I read somewhere that cognitive dissonance is where people make early judgments about purveyors of wisdom they want to hear and say this person I will follow. So, even when shown evidence to the contrary, they will tend to disbelieve it. They have been told this Obamacare is evil, poorly conceived. For example, there are folks you simply cannot convince that Fox News is the most biased news in the US. So, the people I hope to reach are the ones who have not drank the Kool-aid or who have an open mind to the issues and possible solutions. We could spend all day talking about what is broken with the US Healthcare system – unbundling services, billing incidental charges at $75 a pop (stuff like cuffing the blood pressure reader around your arm, etc.), superfluous testing and that is if you have insurance. Thanks for taking time to read and comment.

    • Thanks Jennifer for reading and commenting. I would use that same love button on many of your posts. I thought of you watching the news last night, as they did a piece on converting from coal energy to natural gas in Colorado. The ex-Governor said CO would be 48% coal, 27% natural gas and 25% alternative energy by 2020. Does that sound right to what you have heard?

      • I am assuming that is the Ex Governor Ritter? He was vey active on clean energy issues. This Governor, who I adore for many reasons – he is your kind of moderate – is a little less so. But I think that this Governor will make more progress with his moderate business-friendly approach than Ritter did. If it was Ex-Governer Owens, I would be skeptical of anything he said. I hav a good friend who works for the Colorado Enviromental Coalition who would be more knowlegdable about this.But I believe that a ballot initiative passed that requires the state to be at 25% alternative energy by 2020. So, we will just have to see if we make it. There has been a lot of fracking activity out here and only a few areas are really protesting. Others are raking in the dough. For information, you should check out the CEC website. They do great work in this area: http://www.ourcolorado.org/

      • Yes. And you would love him. He does need a little work on climate change, but his governing style is like Obama’s but more politically effective. He is my favorite Governor I have worked with by far!

      • Thanks. Denver gets a lot of kudos for its handling of the homeless issue. It is my understanding the had a strong interest from the Mayor to back their efforts. So, his reputation is strong. Keep working on the climate change. Even with getting down to 48% coal in 2020, there is no such thing as clean coal.

      • Absolutely agree. We will keep working with him on that one. But so far, he has been one of my gold standards for what I want in a politician, which is high praise!

      • II wouldn’t surprise if you see more of him on the national stage. He is an excellent politician with a Bill gates look and feel. Very likeable, smart and a good bridge builder.

    • Agree with you! LOVE!

      “Get an itemized bill for a hospital stay and shop around beforehand.” If people could do this ONE thing, it would make such a huge difference. There is no discernible rhyme or reason to an average hospital bill, with costs varying widely from hospital to hospital and even from patient to patient in the same facility.

      • Thanks. That is the way they prefer. Confuse and collect. Doctors and hospitals are known to unbundle services. For example, if a doctor did four procedures on a nose operation, an unscrupulous one would charge for four procedures rather than one operation with four steps. Cost difference is huge. Everyone should do what Smokey Robinson recommends – “You better shop around.” Thanks for reading and commenting.

  3. This is a great post. Thanks for bringing attention to what the ACA does, rather than what the political rhetoric claims it does.

    I work in the mortgage industry right now (one more day until grad school!!) and I can confirm that a huge proportion of the bankruptcies that I see are caused by medical issues. The Healthcare Industrial Complex that you mentioned is yet another example of how dangerous corporate lobbying is for democracy.

    Being able to stay on my Mom’s insurance has been a lifesaver for me, especially when I was right out of college and having serious trouble finding a job. I’m very pleased with the ACA provision that prevents children from being denied coverage for pre-existing conditions, too. Years ago, our insurance company tried to deny coverage for my brother because apparently acne is a pre-existing condition.

    • Many thanks. The pre-existing condition issue hits home when a parent loses a job and COBRA runs out and you have to find coverage. I am glad you were able to benefit from the extension on parent coverage until you are 26.

  4. Right on! I was on the Board of Directors at State Compensation Insurance Fund . In 2004 we discussed the fact that employers were dropping healthcare insurance and their employees were using their workers compensation insurance to treat their medical conditions – claiming dust in the air caused their sniffles when they actually had the flu. Either way they received care and the employer saw their mods increase. We seriously discussed the concept of a 24 hour care product that combined workers comp and HMO based care as a way to lower costs and provide better preventative care. The point was workers compensation was and is UNIVERSAL HEALTH INSURANCE for occupational injuries incurred basically between the hours of 7am -5pm for most employees. The employers had control of their insurance costs because the safer their work environment was, the lower their insurance premium. The concept of Universal Healthcare always made sense especially when Richard Nixon first proposed it.

    Our US companies compete with international companies located in 15 countries, all with True Universal Healthcare models. Our US firms has a cost burden their international competitors do not have and it is silly that we continue this imbalance. Our current insurance and group based system has nothing to do with health care delivery.

    The ACA is a good first step towards resolving the most obvious conflict : healthcare is not an insurance product. Insurance is something you purchase hoping to never use it -the exact opposite expectation of someone accessing preventative or critical healthcare services. Insurance companies must be so frustrated with our broken model but they are more than happy to try to limit access, reimbursement and coverage while still collecting premium at as high a level as posdible. I don’t blame them because until 2009, we simply stood by and let it happen. In reality we could simply pay VISA to remit payment to the providers because that is the function the current insurers are providing.

    I blogged about this last month and I was pleased to see your post. Keep preaching, my friend.

    • Vincent (or do you prefer Vince?), many thanks for reading and your eloquent comment. I was watching Bill Maher Friday night and he countered a GOP Congressman’s assertion that people fly here for special surgeries. Maher said only the wealthy can afford to do that. Katty Kay of the BBC who was on the show and she and Maher both recited the WHO statistic saying the US was 37th in quality (I am using 38th from a year older study). The Congressman is illustrative of the “white bread view of the world” from people who are insured and have some money. It is very hard for them to walk in the shoes of someone who has limited or no coverage. The health care experience is much different. I will need to do look at the piece you wrote earlier. Thanks, BTG

      • My mom tells me, ” I could have named you Cleveland so stop calling yourself Vince”. After that, it’s Vincent all the way!

        The reality in San Diego is Americans are going to Tijuana , Mexico for dental care. This is happening right now while the folks with their heads in the sand keep looking for excuses.

        I am more convinced than ever that this election will get regular American off their duffs because the contrasts are no longer subtle. Some of the fast deniers are now in the position to actually hurt real people with their crazy unicorn-level beliefs. If people ever needed a reason to vote for their own self-interest, now is the time.

        GOV. Romney completely understood and still understands why and how the plan implemented in Massachusetts benefits the many that needed the clarity and support. Eventually his current struggle to be someone he is not, should not be, and does not do well will become much more obvious even to his followers. It’s a sad thing to see a man so conflicted.

        Keep up your great work. Your blogs are substantive and thought provoking.

      • Many thanks Vincent. I have tried to send some folks your way via an email to various friends. Thanks for the vote of confidence.

  5. Pingback: Stop being hyprocritical – Obamacare is largely a GOP Idea | musingsofanoldfart

  6. Pingback: Advising young people not to have healthcare insurance is imprudent | musingsofanoldfart

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