Thursday, March 29, 2012

How soon can we come up with a health-care policy that makes sense?

The U.S. Supreme Court
Maybe the Affordable Care Act is constitutional and maybe it's not. If it turns out to be constitutional, maybe it's good legislation and maybe it's not. In any case, it's looking increasingly likely that the Supreme Court, come June, will strike down at least the requirement that everyone buy health insurance. And if the mandate goes, two other requirements will most likely go with it: Once again insurers will be able to reject or refuse to renew applicants. And once again Americans with pre-existing conditions will be uninsurable.*

Let me tell you four short stories about friends of mine. These are true stories, not hypothetical examples. I have changed nothing but the names of the people involved. I am not arguing on behalf of the constitutionality of the Affordable Care Act. I'm just saying that all of these people had serious problems before it was passed, and some of them are doing much better now because of it.

1. John, a pastor, was married to Jane, who worked in publishing. They were well insured - until John came down with a debilitating disease. They would have to rely on Jane's insurance, even though her job was over an hour's drive from their home and John's health-care provider. Changing jobs was out of the question; no new insurer would consider adding John to their policy. So for some 10 years, Jane worked full time, commuted over two hours a day, and worked evenings and weekends as her husband's primary caregiver. When he died, she quit her job and applied for insurance on her own. Every insurer turned her down.

2. Bill and Betty have a child with a learning disorder. When he finished high school, he went to work, but the only jobs he qualifies for are low-paying, without benefits. In addition, the nature of his disorder makes it hard for him to keep a job. He has persisted, however, and he is gradually learning how to be employable. Thanks to the Affordable Care Act, his parents' insurance pays for the medications that allow him to work. They wonder what he will do if his insurance is taken away.

3. Dan and DeAnn have a similar story. Their daughter, in her early 20s, had a life-threatening physical problem that was correctable by expensive surgery. Until it was corrected, she was unable to work and earn her own insurance. Before the Affordable Care Act, she would have been too old to benefit from her parents' insurance, but once the act went into effect, they were able to put her on their policy. This story has a happy ending: she has had the surgery and is doing well.

4. Martin was a truck driver and Melissa was a secretary until a series of illnesses - heart disease, strokes,  ulcers, dementia - forced Martin to quit work and go on disability. Fortunately for him, he is a veteran with excellent health benefits at a nearby veterans' hospital. Melissa took over the full-time home care he now requires. Unfortunately for Melissa, she had no insurance and was too young for Medicare. A strong believer in self-sufficiency, she tried to ignore her arthritis and diabetes. After ten years of giving her husband excellent care, she finally turned 65 and was able to sign up for Medicare.

My stories are all about hard-working, responsible people who would eagerly buy health insurance if they possibly could. Before the Affordable Care Act, sadly, they could not. People on the left and on the right agree - the Act is flawed. But if it is thrown out, what will happen to people like my friends? What will we put in its place? And how soon can we come up with a health-care policy that makes sense?

*If the mandate to buy insurance is struck down but these two requirements are allowed to stand, you can be sure that insurance premiums will skyrocket and the number of uninsured Americans will reach new highs.


Rick Owen said...

Legislation addressing specific elements (such as pre-existing conditions, lifetime limits, portability) can be (and should have been) addressed individually.

Obamacare as it now exists will reduce the availability and quality of care over time, and afflict our economy with greater woes because of what is buried inside of its 2700 pages.

Voters and legislators need to first understand what drives healthcare costs. Obamacare doesn't address this. Once the cost-drivers are understood, then the private sector and legislators can create solutions that make sense and will actually work long-term.

Rick Owen said...

Here's a thoughtful piece which addresses this topic well and outlines a practical solution:

LaVonne Neff said...

Here's an article on how the Swiss deliver better health care (than ours) through a consumer-driven health-care program: A Swiss friend pointed out the article to me, and indeed, her health care is excellent. However, health care in France is arguably even better, and their program has a stronger government component. There are a variety of ways to provide good health care for all - and the United States has chosen to ignore most of them.

Carmamd said...

LaVonne, as usual, has a compassionately balanced story to tell. I've been asked by patients , quite a number of times (in my work as an Urgent Care physician with my group), "so Doc, what to you think of ..." (whaever they call the ACA). My answer is , it is probably a mess, just like Medicare, BUT it is ABSOLUTELY NECESSARY! It is SOMETHING, to cover those who can't get coverage anyway else. Health care reformers have been trying for over 100 years to get SOMETHING, and have always been told by the opposition, "it's too big, too much, too expensive, too soon. Let's study it some more. Let's just let the free market take care of it. Let's trust the free market." Well, here we are, the mess we're in IS the result of trusting the free market. We NEED the ACA. Now.