We can generally tell when this congress is in session because they are “debating” the Affordable Care Act, that change in the US health care coverage arrangements that is viewed by the far right as an effort to impregnate their mothers and get compulsory anal probes by alien forces from Remulon. We have seen threats, tears, and challenges. We have seen thick red veins popping out of short necks and high foreheads in orchestrated town hall meetings. But what we have not seen is a viable alternate proposal.
Let me say that I am not a complete fan of the ACA, but neither am I tearing my garments in abhorrence. My lack of wholehearted support is predicated on my understanding that this tiered system is not sustainable. Because my posts this week are about truth-telling, particularly the directness and vulnerability necessary in it, I will start with some of my own stories about health insurance.
My late husband was a dancer when we met. He was a member of ballet’s equivalent of Equity and got his health insurance from them. Several years after he stopped dancing, he converted the policy he had into a private, self-pay policy through the same insurance company. After paying premiums for a dozen years, that insurer changed names and policies and his was transferred to the new company.
About the same time, he was treated for carpal tunnel syndrome, thought to be a by-product of holding trays of paint in his left hand while he was painting murals on walls and ceilings. Two years later his eyesight became suddenly blurry and a somber ophthalmologist advised additional tests which ultimately resulted in a diagnosis of multiple sclerosis. His initial diagnostic work-up costs topped $70,000 and we sighed with relief that he was insured and had so faithfully kept up the high monthly premium payments while never actually using them.
We sighed again when we learned that the company was disputing the claim, stating that he should have known he had MS because of his symptoms of carpal tunnel syndrome were present when he got the policy. Even though we knew that there had never been a gap in coverage, the companies involved saw his earlier transfer of policies within their own system as new coverage. They had a phrase tucked into the policy that defined pre-existing conditions in a way that was later deemed illegal by the state, but this was two years after it was already too late for us. Paul declared bankruptcy and pretty much lost everything fighting for disability coverage under SSI and Medicaid.
These experiences 14 years ago propelled me back to my own childhood, when my father was deemed uninsurable because of heart disease. He at times kept jobs he did not like, at pay that was insufficient, because he needed health care coverage if we were to survive as a family. My dad was an accountant by training, but he worked as a time-keeper in a factory for the insurance offered. I recall him changing jobs a couple of times and the attendant worry that shrouded him and my mother during those transitions. We would need to risk loss of coverage for a month or more for him to get a better job.
I have also personally negotiated health care coverage for a couple dozen employees, ranging in age from 20 to 65. The questions were numerous and numbing. High premiums or high deductibles? Flat rate across the workforce or differential premiums for females of child-bearing age? Coverage for same-sex couples was viewed by many as a great benefit, but few realized that the benefit was taxed unlike for their heterosexual peers.
Paul and I have navigated the choppy waters of health care coverage and generally did okay. Paul ultimately got Medicaid and Medicare. At age 65, I got Medicare coverage with supplements, initially employer paid and now personally paid. For both of us these were incredible improvements over our previous options which had surpassed $15,000 a year each. Medicaid, Medicaid Expansion, and Medicare all work, though they could work better. It is very difficult to find some specialists that will take this coverage unless you saw them prior to converting to them. Still others put a cap on the number of Medicaid or Medicare patients they will see. This is particularly shameful because in reality these two systems in effect paid for the bulk of their medical training.
The extreme Right is correct in its assessment that the Affordable Care Act will not work (for long), but not because the policies go too far as they assert. The ACA will not work because it does not go far enough. The ACA makes sense as an algorithm on paper. However, like all other algorithms, the component parts of the ACA must all be in place for it to work. The component parts of the ACA are not all in place to the extent that it’s engineers had hoped because they failed to account for the greed in the health care, pharmaceutical, medical equipment, and health insurance systems.
Some local health care systems have exceeded their revenue goals by hundreds of millions of dollars under the ACA. Costs of medical equipment and drugs have continued to rise almost unabated. The numbers of employees in health insurance companies and in health care billing offices have grown at rates twice as large as those of actual health care providers. The business of the ACA has outstripped the actual care. This has turned into a boon for the industry, but much less so for actual patients.
The billions of dollars poured into the hand-full of electronic medical records companies during the 2008 economic recession through stimulus packages did not produce what they might have either. Check your own records some time. I discovered that I have diabetes (which I don’t) and asthma (which I don’t). The former diagnosis comes from a single wonky blood test done during a hospital stay for a heart attack. All of the other blood work done at the time was normal, but this particular sample showed several extreme results never found again, suggesting to me that it was either not my blood or that the test was not accurately calibrated. The diagnosis of asthma did not come from any clinical evidence at all, but was the result of getting a prescription for a single inhaler to end a lingering cough following bronchitis. No wheezing. No problems breathing. A prescription for a cough. In other words, nothing environmental or genetic or behavioral was making me sick. My health care record was.
We must face that the Affordable Care Act is not affordable. Similarly, we must not be confused by United Health Care and the other big players acting all victimy because they are losing money. The health insurance industry is making zillions in profits for investors, and you and I are paying for it. While I continue to applaud our President and the architects of the ACA, I do so because they have managed to move forward our continuing challenge to provide care to people who need it. The current solution far surpasses the failed attempts 20 years ago under the Clinton administration.
It will still fail.