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.