Thursday, May 19, 2011

Health Care Reform in America

In my previous post, I wrote about my recent cataract surgery and pending corneal transplantation surgery. I consider my healthcare costs to be very high, easily equaling half my income. But at least I was able to get my eyes operated on and perhaps my vision will be saved before it's too late. What about those without insurance? What about those who delay care or never see an opthamologist and must accept blindness? I will not accept that in the world's richest and most advanced country that we have this as the sad reality, that more than 30 million people do not have health insurance nor access to the medical care they need.

I'd like to make an analogy to help explain Healthcare in America before the Affordable Care Act (so-called "Obamacare") was passed last year. If you have used airline travel since deregulation in 1978 when all government controls over routes, fares, and market entry were removed, you know it is very difficult to understand the costs and services for air travel today.  The consumer cannot compare costs and services very well because there is little or no transparency. Most of us use middlemen (travel web sites or Travel Agents) to book our travel and,  like insurance agents, they get a piece of the ticket price.  Corporate/business flyers who travel the most get a lot of bang for their buck including Frequent Flyer Programs that bring them free additional air travel. People of moderate income or those who travel less, are confronted with different levels of confusing rates and lots of additional expensive fees for baggage, meals, legroom and the like.  One airline passenger will often fly for an inexpensive discount fee of $200 right next to a full fare traveler paying $600 for the same distance, seat, and service (kind of like the middle class consumer who may have employer-provided health insurance or who must purchase health insurance individually).  Of course, there are those who can't afford to buy the airline ticket at all and they must be satisfied taking the bus or train, taking a while longer to get to where they need to go or passing up on the trip altogether (like small businesses, the poor, and those with no health insurance at all).  Then there are those on the "No Fly List" (equivalent to health care consumers with "pre-existing conditions")  who cannot fly at any price.  They end up "thumbing for a ride" hoping that maybe someone will pick them up and get them all the way to where they need to go.  That, in a nutshell, was how healthcare in America has been working.

For those who know me or have read previous posts from me on health care, you know that I am a supporter of the Patient Protection and Affordable Care Act of 2010 and that I follow legislation on insurance companies and on health care reform very closely. During my life, I have experienced military healthcare (back then, it was US Navy Hospitals and clinics) as a dependent of a career Marine, college student on-campus health clinics as part of my student fees, community clinics and Planned Parenthood clinics on a sliding scale basis, no insurance at all when employed by small businesses, employer-provided medical insurance where I paid 0-20% of the premium, Health Savings Accounts (HSA's), COBRA Insurance Continuation Plans where I paid 102% of the insurance premium, and finally a State Plan for people with pre-existing conditions unable to obtain an individual insurance plan. I have also negotiated with employers and insurance companies as the chief negotiator of my labor union for healthcare and dental insurance benefits. In addition, my father-in-law was a physician as is my sister-in-law. I currently have a daughter without medical insurance on a waiting list for State Coverage Insurance (SCI) because enrollment is full. She pays for her few doctor's visits with cash or goes without medical care or has had to go to the UNM Hospital emergency room for emergency care,  waiting for as much as 11 hours and leaving without treatment. My husband is a disabled veteran and gets free medical care from the Veteran's Administration using the VA Hospital and doctors here in Albuquerque. He has recently signed up for Medicare - Part B after delaying for 6 years, so now he can get medical care in non-VA facilities for a monthly low premium and co-pay.

I mention all this to illustrate that I am very familiar with the state and cost of health care in America on a personal and first hand basis. Due to an abundance of misinformation about the Affordable Care Act, most people are ignorant of the provisions and benefits of the new health care law. An easy to understand website and navigating tool to help families, small businesses, and individuals currently without health care select the health care option that fits your needs under the Affordable Care Act is here.  The new law, passed a little over a year ago,  is comprehensive reform of insurance-based medical care and government-run programs like Medicare and Medicaid,  implemented over a four year period. Among its many benefits, the law creates transparency for the consumer on costs and quality of care, provides tax incentives and assistance to help small businesses and low income persons and persons with pre-existing conditions to obtain medical insurance, insures that medical pools are large enough to keep premiums in check, reduces or eliminates student debt for those who obtain medical training and degrees and agree to serve in high need community clinics, increases the number of community medical clinics, stops insurance companies from denying individuals insurance because of pre-existing conditions, prevents insurance companies from cutting off patients with serious medical conditions, implements cost-saving initiatives that reduce costs and fraud while improving care, and provides financial incentives for early retiree reinsurance for employers whose employees (age 55-64) retire before Medicare benefits start at age 65.

Unfortunately, there are such partisan divisions in our country so that healthcare reform is struggling against a tide of well-financed propaganda .  During 2009-10 when health care reform was being discussed and legislators conducted Town Hall meetings to explain elements of pending legislative bills, Americans for Prosperity helped organize inflammatory rallies that created and perpetuated myths about  health care reform comparing it to genocidal campaigns of Stalin, Hitler and Pol Pot.

Americans For Prosperity is bankrolled by the Billionaire Koch brothers that tries to paint the Affordable Care Act as "socialized medicine" and Republican politicians are trying very hard to undo and unfund the Affordable Care Act. In my State, the Republican governor vetoed the establishment of a Healthcare Exchange passed by the State legislature. Her veto rejects $1 million from the federal government to help New Mexico set up a marketplace of existing insurers for consumers to compare and purchase healthcare insurance products in preparation for the full implementation of the Affordable Care Act in 2014. This kind of thinking that "if we don't pass any laws preparing for ACA, it won't happen" is not only short-sighted, but is irresponsible to the majority of citizens of New Mexico who seriously need affordable healthcare. Indeed, 25% of New Mexicans have no medical insurance at all.

There has been plenty of criticism of the new health care law from both sides of the political spectrum. Many voters representing the left wing of our country were disappointed that the health care law passed in 2010 was not Single Payer or Universal Health Care and they bemoan that private insurance-based medical care will continue to raise premiums to enrich corporations.  Other voters of the right wing and the Tea Party criticize the new health care law as another "big government program" that puts government controls on our relationship with our medical provider.  Given the extreme political divide in Congress and among the voters, it is my opinion that compromise is the only means to make meaningful changes in reforming health care today.  To do nothing at all would have been unacceptable given the huge medical cost that eats up our national budget as well as family budgets.   Further, it is unacceptable that our wealthy country has so many citizens who cannot get health care at an affordable cost or even at any cost at all.  After years of doing nothing because of intimidation by the health care industry, finally our leaders in Washington acted to craft reform.  They ought not to be castigated, but instead, they should be applauded for their courage to act.


  1. I am always hesitant to comment on the policies of another country but I can discuss our health care system here in Canada.
    We all have coverage from before we are born until we die. If your income is low enough you do not pay for it. If your income is high enough you pay monthly premiums based on how many people in your family. When the kids turn 19 they get their own separate coverage unless they are in school still.
    We all have basic coverage that entitles you to visit any doctor you choose whenever you choose. It covers any specialists that your family doctor may refer you to. It covers the majority of all hospital costs.
    It covers a set amount of chiropractic, massage therapy, acupuncture and many other more holistic treatments.
    Many employers also offer what is called Extended Medical which covers your ambulance costs, your crutches, and so many other things.
    Is this a perfect system? Not by far. We have long waits for hospital care and emergency wards but for the most part I can't imagine life without it.

  2. I know many Canadians who value their national healthcare very highly. Managed care helps keep healthcare costs down and affordable to the greatest number of people. I have observed the snobbery of people who look down on government or managed care like HMO's as something they would never use. As a child, I remember long waits in Navy clinics to get medical care, but it was free to military families so we didn't complain that much. Eventually, the Navy outsourced military dependents medical care in the form of Champus and now Tri-Care. When I worked for a large company with health care benefits, I selected Kaiser Permanente HMO although more expensive indeminty plans were available where you could see any provider you pleased. Kaiser kept costs low, broke ground with their emphasis on healthy living and prevention and Urgent Care that kept costs low and quality high. It was non-profit, doctor-owned medical care. I used Kaiser for 27 years and had two babies born at Kaiser Hospitals. Still, HMO and Managed Care were the anathema to the AMA and for-profit insurance companies because, let's face it, sick people equal PROFITS.