ObamaCare Sidestep

As a practicing physician serving the homeless, uninsured, and disenfranchised populations of the world I would characterize the Affordable Act as neither a step forward, nor a step backward, but rather simply a side step around the major obstacles towards affordable sickness care.

You’ve heard by now that the United States Supreme Court upheld most of the Affordable Care Act designed to make steps towards improving the national illness care delivery system.  The Supreme Court preserved the individual mandate to purchase health insurance, which I will refer to as illness insurance.  The Court also limited an important portion of the Act designed to encourage States to expand their illness insurance programs (Medicaid) for poor and disabled people.

The traditional historical viewpoint has always been that illness insurance gained popularity as medical care and interventions started to become more “scientific” and consequently more costly.  However, the private illness insurance industry grew substantially in the 1930s during the Great Depression when people and hospitals were experiencing falling incomes.  Illness insurance plans offered hospitals a secure income and eased the economic burden of sickness care on patients.  However, because the patient wasn’t paying the full bill, doctors and hospitals felt comfortable inflating their fees and charges.  And thus the upward spiral of medical costs began.  Now, hospitals can charge $20-50 for a piece of plastic tubing.  Inflated pricing has nothing to do with advances in technology.  Notably shares of hospital chains jumped with today’s ruling.  The Affordable Act does nothing to stem the rising cost of medical care and ultimately gives a step up to the “corporate takeover” of medicine.

Private corporations, whose primary motives are profit, need to be extricated from the business of sickness care.   As a clinician I spend too much time changing a person’s prescription because insurance, private or government, doesn’t cover it.  This week a homeless patient requested lysine, an amino acid known to keep recurrent herpes at bay. He ended up with a prescription for a chemical medicine that ultimately is more expensive ($100/month) because his insurance would cover it but wouldn’t cover the lysine ($10/month).  Adding to the confusion, sometimes insurance will cover the 40 mg tablet of a medicine and not the 20 mg tablet.

The decision not to promote the expansion of state illness insurance programs (Medicaid) is a harsh blow to the people I work with every day.  Instead we should have done everything in our power to cover more disenfranchised people for the services they desperately need without making them jump through hoops, spend down their life savings, and abstain from meaningful productive work, that may not include illness insurance, lest they lose the illness insurance the state provides.

The big hurray in the Affordable Act prohibits private insurance companies from refusing coverage due to medical history or risk.  This is HUGE!  Furthermore they have to renew policies as long as premiums have been paid regardless of medical status.  This is HUGE!  And they cannot dilute or decrease coverage for anyone who becomes ill.  This is HUGE!!  There will now be limits on out of pocket spending through deductibles and co-pays, and no lifetime limit on coverage.  This is HUGE!!  This provides an immense degree of security and stability for people who can afford insurance, particularly those who are covered through their employer.  The Act attempts to lower premiums for small business employers.  However, it isn’t clear to me how insurance premiums will be controlled or capped for those who are self-employed to now buy insurance regardless of health status.  One must remember that the tradition of employer based illness insurance arose in the 1940s during World War II when employers were prevented from using wages as a means of competing for scarce labor.  Employers started offering illness insurance as a benefit instead of higher wages.  Sickness care should still be affordable to people who work independently.  The only method the Act offers for controlling insurance premium pricing will be for states to apply for federal grants to review premiums being charged.  This is a highly inefficient method of ensuring affordable illness insurance.

There are three glaring omissions in the Affordable Act, the lack of dental care, vision care, and occupational injuries and illnesses.  The teeth and the eyes are part of the body and are important to the overall wellness of a human.  Stay tuned for the next episode of Nei Jing Now in which we will explore oral health and why it hasn’t traditionally been included in illness insurance coverage.  The current worker’s compensation system is only applicable to people working in businesses with 10 or more employees.  Once again the independent worker is completely left out.  Many times people, the physician and the patient, don’t even recognize that the illness or injury is work-related.  Sometimes they don’t want to recognize it as such because the Worker’s Compensation paperwork is such a hassle.  All injuries and illnesses of the mind and body, regardless of cause, including the eyes and the teeth, should be covered under one national illness insurance program.

As Americans can no longer be denied coverage I celebrate the Supreme Court’s decision.  I will still be spending too much time decoding which medication is covered at which dose.  I will still be hassling with unnecessary paperwork rather than listening to and caring for people.  Big Pharma, the Insurance Industry, and Corporate Medicine will still inflate pricing and medical costs will continue to rise.  Even as it’s lacking, the Act is an important first step on a long road to creating a fair and equitable illness care system. 

Finally, I want to distinguish between health policy and illness care insurance policy.  All human activity has an impact on health, human and otherwise.  That means ALL policies are health policies.  Medical care doesn’t necessarily translate into healthy happy people.  Yes, sickness care has the potential to alleviate suffering by any amount, with no guarantee of enhancing happiness or well-being.  Illness insurance can help relieve the burden of the spiraling costs of allopathic medical care and interventions. Ultimately creating health is our individual and collective responsibility.  Primary prevention is still the most affordable method and completely within our power. 

Please share your thoughts.  Nei Jing Now would like to know from you! 

(Also, please allow me to refer you to a statement from Physicians for a National Health Plan in response to today’s Supreme Court Ruling.)