Diagnosis for Democracy
Insights into the State of Our Union
A Blog by Rob Tenery, MD


The Difficulties in Providing Health Care Coverage to the Uninsured

By Rob Tenery, MD on January 30, 2017

 

On March 23, 2010, President Barack H. Obama signed into law the Patient Protection and Affordable Care Act (PPACA). From its inception fourteen months before, it has been one of the most contentious pieces of legislation in recent memory.

Our forefathers could have predicted that at some time in the future, this country could no longer afford to offer all of the available medical advances to everyone. Our country arrived at this point because our forefathers fought and died to ensure the existence of a free enterprise system that encouraged and rewarded research and development. We should not alibi, because this country has the best level of health care in the world. However, we must find solutions for our present problems so that our children and their children will enjoy an even greater level of physical well-being.

The United States ranks forty-sixth in infant mortality rate at 6.26/1,000 live births—far behind Japan at fourth, France at eighth, the United Kingdom at thirty-second, and Canada at thirty-sixth. Another measure of the health of a nation is life expectancy. In this category, the United States ranks thirty-eighth, behind Japan at number one, France at tenth, Canada at eleventh and the United Kingdom at twenty-second.

Another area that must be addressed is the politically unpopular subject of the 11.7 million (and counting) undocumented immigrants who flood the emergency rooms of the “charity clinics” and have their babies in this country. Allowing newborn babies citizenship (anchor babies), just because they were born here, without regard to their parents’ status, is an unaffordable burden on our public funding systems such as with the Aid to Families with Dependent Children (AFDC) and Medicaid programs. Without meaningful and enforceable changes in how this country deals with undocumented immigration, any health care reform legislation is doomed to problems and possibly failure. The two problems are inextricably linked.

For the health care delivery system in this country to be able to offer quality medical care at an affordable price, there must be compromise. It can only come when the majority of the special interest groups look beyond their own agendas and to the greater good. There must be incentives put in place—not just punitive incentives set down by legislative fiat, but incentives that reward patients who do not over-utilize the system and live healthier life styles, take advantage of preventive care measures, and seek care earlier in the course of their maladies. These incentives would make them prudent purchasers of their own health care services.

This concept is not a delivery system in itself but a funding mechanism for payment of health care services, which can be incorporated into most existing systems. It allows patients to make the judgment as to whether the medical services in question justify the costs, often referred to as the cost–benefit ratio. To be successful, the methodology must be affordable.

This brings us to the third area of the debate on health care reform: control. But control by what sector of the community? Control by the health care providers? Although doctors and other providers receive only about 20 percent of monies spent, supposedly they have control over at least two-thirds of where those funds are going. The patients have control over their lifestyles and when in the course of their illness they seek care. Increasingly, with limited resources and monies to fund them, the patients’ role is becoming more passive. That leaves the payers: the insurance companies, the lawmakers, and the federal funding programs. Looking at the recent fourteen-month debate leading up to its passage, the final piece of legislation was determined by a bare majority in Congress and a president who based his legacy on its passage. Although all three parties still have input, it is seems clear that the doctors and their patients have “given up some ground.”

With the passage of the ACA legislation there are those who feel that this country has moved one step closer to a single-payer system: a system with no debate and very few options. A monopoly. With the new leadership in the White House and the Congress, there is a real opportunity to keep the good parts of the current legislation--- cover pre-existing conditions and extend dependent coverage under the parents’ insurance--- then introduce competition for private coverage across geographic boundaries, variations of medical savings accounts, vouchers as supplements and more patient responsibility for affordable first-dollar coverage.

Instead of allowing open access to health care where the only penalty is longer wait times and shortage of resources, we need a system where the patients are once again their own ‘gatekeepers’, but only to the point they can afford. Remember how President Obama and his then Speaker of the House Nancy Pelosi strong-armed her fellow representatives when she implored them “to pass the bill, so that you can find out what’s in it.”

Let’s not make that same mistake again!*

* Article excerpted from In Search of Medicine’s Moral Compass, Tenery, R., Goodman, L., The Small Press at Brown Books Publishing, 2011.

 

 

 

 





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