I usually don't mix politics with literature. Hemingway said that the popularity of partisan writers rises and falls with the winds of political change. You are up as long as the view you espouse is popular, but soon forgotten with changing times. Politics and religion are generally taboo subjects for fiction writers, at least outside the safe bastion of fictional worlds, because you don't want to alienate your readers. But this Independence Day I shall make an exception.
Recently the Supreme Court upheld the Affordable Care Act, more popularly known as Obama-care. The act sought to make healthcare more equitable and affordable through government regulation, never a good idea. There are numerous good provisions in the law – allowing young people to remain on their parents insurance, preventing insurance companies from raising premiums or dropping coverage on those who become ill, requiring insurance companies to cover those with pre-existing conditions – yet there are other provisions which make the problems worse. Leave it to government to screw things up.
We need healthcare reform, everyone agrees on that, but most of the debate for or against 'Obama-care' revolve around partisan arguments. The argument before the Supreme Court was twofold – the individual mandate (requiring all Americans to purchase coverage) and the expansion of Medicaid to cover those unable to afford insurance coverage. The court upheld one and threw out part of the other. I had no problem with either.
My problem with the ACA as it stands is the provisions that are already lowering the standard of care for patients. My son was diagnosed in January with leukemia, so I have become intimately aware of the problems in our healthcare industry. Thanks to the ACA he can't be dropped by our insurance, but thanks to the ACA we have found there are limits imposed on his care – not by his doctors, but by the insurance company and the hospital. Those limits are not only allowed under Obama-care, they are encouraged.
Some partisans have pointed to the specter of care being denied to the elderly (politicians love to scare old people) and 'death panels' to decide who does and doesn't get care. Others argue those claims are farfetched fear-mongering. Perhaps. But in my son's case we have fought the insurance company on numerous occasions to allow drugs and treatments our doctor felt necessary yet the insurance company didn't consider cost effective. That intrusion by insurance companies became common even before the ACA, but is encouraged under “healthcare reform” as a way to manage cost.
At my last physical I paid the doctor cash for a diagnostic test my insurance company said I didn't need because there was a cheaper, less accurate test available, but I have found that the doctor's hands are often tied and they can not perform some procedures unless authorized by insurance agency watchdogs. One of the cost saving ideas that bring up the specter of 'death panels' is the idea of unit pricing or event pricing. In that scheme the facility (hospital or clinic) negotiates a pricing deal with the insurance company in advance for different procedures/events.
In my son's case the hospital and insurance agency have negotiated a set price on treatment of leukemia patients. That means the insurance company pays the hospital a set fee, and the hospital accepts that as full payment for the patient's hospital bill. Now if my son does exceptionally well in his treatment and his hospital stay is shorter than average and he requires less medication from the hospital pharmacy the hospital makes additional profit. If he has complications and spends more time or needs additional medications – say for nausea – then the hospital loses money. So the hospital pressures the doctor to release him from inpatient care as quickly as possible and pressures the nurses to limit how many medications he consumes during his stay.
Yes, this actually happens. We have been told there are shortages of nausea medications, even shortages of bicarbonate. Our oncologist has been forced to intervene on a number of occasions and demand medications she ordered be released by the hospital pharmacy. We have even resorted at times to using medications we purchase ourselves from our local pharmacy. These aren't real shortages, they are 'event' shortages – which means the hospital has designated a set amount of medications to be used during my son's hospital stay and he is using, in their calculation, too much. He is going over their price calculation for that billing event and costing them money.
In the case of hospitals and clinics, paying the doctor out-of-pocket for additional treatment is often not possible. The heartless accounting departments at the hospital and insurance company can't allow for such non-standard treatment. Their pre-negotiated standard treatments/payments are unyielding. Under the paradigm of the ACA all care will be substandard and uncompromising. Strict government guidelines and meticulously calculated rates will only allow the level of care deemed most cost effective – most profitable.
My son has leukemia. I don't give a damn about the cost. If I have to sell my house and live naked on the street I want the best care possible for him. When he is puking his guts out I don't want to hear there isn't nausea medication available. In our case we have jobs and private insurance. I can sometimes purchase medications at the local pharmacy and supplement the hospitals 'limited supply,' but those with lower incomes who are stuck with the standard 'public option' are also stuck with the standard low-cost care provided.
As time passes we will all be herded into the 'public option' as insurance plans will mirror the minimalist government requirements. Care will be fair and equal for all, but the standard will suck for all as well. Cost cutting provisions of the ACA will create defacto 'death panels' as accountants, not doctors, decide what care is 'necessary' for our condition and what can be limited in order to cut costs. The individual mandate, which the Supreme Court upheld through convoluted redefining of terms, will allow insurance companies to minimize the coverage and maximize the profits while meeting the minimum requirements of the law.
Under Obama-care we will all get healthcare coverage, but only the most basic and cost effective. There will be no more people saved by new expensive treatments, no more expensive research, no more dramatic breakthroughs in medicine. We will have what the insurance industry and the healthcare industry accountants allow us to have, within their pre-prescribed spending limits and hefty profit margins. Doctors, nurses, and healthcare providers across the country are complaining about the ACA for those very reasons. It's not political. Our government is once again propping up a bloated corporate structure on the backs of the people. Healthcare reform was a good idea, before the government sold us out to hospital and insurance conglomerates.
My son is still undergoing treatment for leukemia. It is a long and expensive course of therapy. He is twenty-two years old, one semester away from graduating college, unemployed, and overburdened with college loans. His mother and I help all we can and add to our personal debt daily paying co-payments, deductibles, and non-covered expenses. If you can help, please click the donation link below. All money collected goes directly to Joshua.