ALPERN AT LARGE-Amidst all the spinning, posturing and diverting that surrounds the less-than-smooth (OK, maybe it's even disastrous) rollout of the Affordable Care Act (ACA) is the lack of focus on health care professionals who are trying to make a difference in the lives of their patients. I recently threw in more than my own two cents that we've yet to START making healthcare truly affordable. [article]
But the Affordable Care Act, rather than make healthcare more affordable and accessible, appears to:
1) Make health care neither more affordable nor accessible, and it's not just the flawed website--which is more of a bellweather of things to come, rather than an isolated problem, as indicated by those not signing up after they DID get the website to work. While it is wonderful that previously uninsurable individuals are covered, it's not only the Motley Fool that is questioning whether the ACA will fall apart.
2) Have proven the critics of the ACA correct--young people are NOT flocking to sign up, despite the inane "Got Coverage" ads meant to attract them to get coverage. If the ACA has problems then the President's "fix" has just as many legal and fiscal problems that remain unaddressed, to the alarm of the states and health plans that have to figure this all out.
3) This is a Presidential Administration that has been no more kind to whistleblowers than its predecessor, as evidenced by the recent firing of Washington, D.C. insurance commissioner William P. White.
4) Be a law that Congress, the President, the Supreme Court and the federal workforce remains exempt from, and which under the President's "executive" (some have preferred the words "dictatorial" or "imperial") decrees has been only delayed for a year to all enrollees and employers who fear the impacts of this rollout...which makes it anyone's guess what will happen when everyone HAS to sign up during the 2014 election season.
But I've heard from, and read from, opinions from all over the political spectrum--some want an end to all insurance, some want single-payer insurance, and some just resort to name-calling. I have ALSO heard from, however, a combination of conservative Democratic, independent and Republican individuals who want to make the intent of the ACA work but without the problems that are now glaringly evident.
These latter individuals are the ones who I think merit the most attention, because these are the ones who want the fixes to our health care system and who--unlike Nancy Pelosi and Harry Reid (who are the true authors of the law, despite the name "Obamacare", and who passed the bill more for partisan and ideological reasons than on doing what was right) care more about the country than they do partisan politics.
1) Medicaid really is problematic, inefficient and ripe for both corruption and waste when it's fee-for-service, but is both more profitable and helpful when it's managed by outsourced private plans. I have both fee-for-service and managed-care Medicaid (called "MediCal" in this state) patients, and the latter almost always has better management and outcomes than the former.
2) While income taxes aren't going away, I favor a focus on sales tax increases for the future to make sure that everyone pays into a system that will help all individuals.
3) While the GOP has had no great comprehensive response to date, much of their approach to health care reform was and is to tinker and make one little change at a time to a very complicated issue, rather than completely re-invent everything. The GOP-hating media doesn't help at all, and have made things worse--the hidden surprises of the ACA are very much because of a media that remains more partisan than enlightening.
4) Forgotten was the time when Senate Minority Leader Mitch McConnell recommended a few changes to the ACA that would have brought some 80 senators on board, but the media, the President, Pelosi and Reid wanted a Democratic victory, not an American victory. Healthcare is a bipartisan issue, and I don't know ANYONE who truly wants sick people to go without healthcare.
5) The Perfect is the Enemy of the Good, as the expression goes. We honestly DO need a choice of barebones to comprehensive plans with a definition and affordability of "barebones" that is different than what the ACA demands. A more flexible size of one's deductible is an idea that should be coupled with enhanced Medicaid eligibility and requirements.
Ditto for allowing those on welfare and the working poor to make sure THEY are paying into the system when and where they reasonably can. Michigan had a bipartisan approach, as recently described in the New England Journal of Medicine which both expanded Medicaid, encouraged patients to save money with Health Savings Accounts, and which emphasized a balanced budget.
6) Non-droppable coverage is a first-rate concept that should be emphasized, and an aforementioned barebones plan that young people are required to pay into (no more than $50-100 a month, come hell or high water) should be spelled out as such. This was and is a bipartisan sentiment that has never been fairly reported by the media--untruthfully dehumanizing GOP leaders and Republicans as being OK with sick people losing coverage just won't help fix this problem.
7) Health savings accounts should be expanded and tax credits should be expanded, too, as well as expanding health plans across state lines to encourage competition and lower costs. The income redistribution is too big, and the encouragement of all to save and spend on their own health is too underemphasized, in the ACA.
8) The allowance of families to cover their adult children while they are in college and graduate school is one that might require parents to pay more, but this is a good part of the ACA that the GOP demonizes too much. Still, the concept of young people in their twenties paying more is still fundamental for any plan to succeed--irresponsible behavior is just that.
9) The divvying up of coverage of high-risk, high-cost individuals to all health plans is a good idea, as is the idea of having all health plans throw a percentage of profits at a high-risk pool managed by the state and/or federal government. Preserving coverage for the sick is critical ... as critical as it is to have this coverage paid for in a reliable and sustainable fashion.
10) I again remind you that governmental workers and their families are exempting themselves from the ACA, which really is the end-all and be-all of this argument.
We have a Statue of Liberty, not a Statue of Equality, in New York Harbor, and while we are all created equal it goes against the principles of our country and of human nature to presume that we all want the same thing in life, and have the same priorities and solutions for every individual. Ditto for healthcare...and the necessary enhanced flexibility of the ACA's demands doesn't mean we can't require a baseline while allowing more options and flexibility for individuals to be...individuals.
So to my fellow Americans who are either Obama-apologists or GOP ideologues (actually, both groups are obnoxious ideologues), perhaps it's time we actually fixed our health care costs and coverage problem. Perhaps it's time we got past an "Obamacare" and focused on an "America Cares" approach to ensuring the health, financial and quality of life needs for all Americans.
And for those who won't...perhaps the problem is that YOU don't care.
(Kenneth S. Alpern., M.D. is a Board-Certified Dermatologist/Dermatologic Surgeon who is a Westside Village Zone Director and Boardmember of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Co-Chair of its MVCC Transportation/Infrastructure Committee. He is co-chair of the CD11 Transportation Advisory Committee and chairs the nonprofit Transit Coalition, and can be reached at [email protected] This email address is being protected from spambots. You need JavaScript enabled to view it. . He also co-chairs the grassroots Friends of the Green Line at www.fogl.us . The views expressed in this article are solely those of Mr. Alpern.)
-cw
CityWatch
Vol 11 Issue 93
Pub: Nov 19, 2013