Monday, September 30, 2013

Understand the health care act before slamming it

As Oct. 1 brings the nation to the first major step in implementing the Affordable Care Act, or Obamacare, all manner of media are reporting, analyzing and generally trying to bring clarity to a murky and difficult topic. The difficulty of this topic arises from the unique nature of health economics and the egregiously wrong application of general economic and free market principles to the discussion of health care.

While much of the rock-ribbed conservatives are railing against the ACA, the nation as a whole supports health care reform and much of the country is willing to give the reform act a chance. I spent 25 years in all aspects of the health care industry, with my early years witnessing the implementation of Medicare and Medicaid. As a journalist for some18 years, I always had health care as a beat. I have only seen a handful of reporters who “get it” and can explain how the system works. Nevertheless, I would offer these observations:

• First, I heard all the same arguments in 1967 with the passage and implementation of Medicare and Medicaid — and those programs turned out to be a boon for the hospital and health industry. And physicians no longer had to trade services for chickens.

• Second, most of the people posting about and complaining about the ACA are ill-informed and don’t understand anything about health economics, including the concept that the “free market” doesn’t work for health care. It never has and never will. If you want to make intelligent remarks about the ACA, learn about health economics and health insurance. Or get a master’s degree in health care like I did and then come back and make a fact-based argument about these issues.

• Third, the entire underwriting concept of the ACA working is community ratings, which deals with the issue of pre-existing conditions and other matters. It means that we’re trying to spread the risk over the widest population base possible. This will, in the long term, lower costs and accommodate the pre-existing conditions. It will also accommodate, from an underwriting standpoint, the more robust benefits the act imposes on insurers.

• Fourth, one of the reasons the ACA passed was the private insurance companies, BigPharma, hospitals, the organized physician community and the medical equipment industry “got theirs” as part of the bill. The negotiations with them saved the legislation. And, by the way, don’t believe the lies that the GOP tells abut not being part of the process: Iowa’s Chuck Grassley and Sarah Palin being two of the biggest liars claiming the GOP was cut out of the legislative process. The GOP was invited and didn’t play. It’s a typical bush league tactic.

• Fifth, saying government can’t run anything efficiently and it will make the act unworkable isn’t accurate, as popular as bashing government may be. Claiming government can’t run anything well isn’t accurate when focused on health care. Medicare has the lowest retention rate of all the insurers, which is a good thing and reflects the program’s efficiency. In short, it’s run better than all the private insurers could ever hope for.

• Sixth, the ACA has a long-range implementation period and, like Medicare and Medicaid, will need amendments, adjustments and other tweaking. Perhaps, as part of the tweaking, a certificate of need program like the one we had in the 1970s (before Ronald Reagan’s administration ruined it by buying into the “free market” health care idea ruined it) would stem some of the costly competition in capital expenditures. Perhaps a return to regional  comprehensive health planning would make sense.

Seventh, the law is constitutional. Those who argue otherwise reject the rule of law. You can't cherry-pick Supreme Court rulings for their legitimacy.

Eighth, objections without constructive discussion is useless.

Finally, for those citing individual cases, you're too narrow. This is a systems problem requiring a systems overview.

Somehow the vitriol and disinformation about public policy decisions has to stop for us to solve our problems — but that’s another topic.


  1. How about MY individual case. Let's see if what is happening to ME is too damned narrow.

    I am in my mid-50s, permanently disabled by chronic illness and now have a new, terminal illness.

    Because of the rules of the ACA, as of Jan. 1, 2013, I could no longer receive curative care. The only care for me is palliative. Because of formulary changes because of the change to only palliative care, I could no longer get Ranexa -- unless I wanted to pay $535 a month. It was the medicine doing the most good for my congestive heart failure and accompanying issues.

    I was diagnosed with prostate cancer in June. Because of the rules dictating I can only receive palliative care, I can not receive curative care for the cancer. No radiation, no chemo, no nothing.

    IF we had been able to launch immediately with radiation treatment, we could have nipped this in the bud. However, by the time my appeal went up the bureaucratic line to Kathleen Sibelius, the adenocarcinoma had gotten into my bones and my lymph system. While we are waiting to hear from Secretary Sibelius, the cancer has made its way into my urinary system. It is throughout my pelvic/groin region. I now have a malignant mass in my right kidney. It also has a fondness for spinal tissue, and is already attacking the base of my spine.

    My doctors believe that had we been able to attack this immediately, I had a good shot at beating this.

    I'm sorry that this is an individual case and I am too narrow. Just thought you might want to hear from a victim of ACA. When I die, which my doctors say will be within a year, be sure and hold me up as a shining example of how good the ACA is for all of us.

  2. See also:

  3. If I may be arrogant enough to hazard a bit of advice for Mr. Pepper and his existential dilemma of facing death. Please accept reality, let the circumstances be what they are, transform consciousness to be wholly present here, now. Without emotional resistance, allow karmic working of the dual mind to completely negate your sad story. For lack of integrity or courage to face the inevitable, why should the significance of your fifty five year life and the whole of reality be held hostage to such a state of personal chaos for the sake of one more year of personal misery? So let go-----you may be surprised to find a pony under that pile of manure.