Friday, June 7, 2013

unhealthy disappointments

ryan said, "it wouldn't be tuesday if you weren't freaking out about health care."

it's not tuesday, but let's talk about it anyway.

some pundits have been lauding the changes currently under way to the american health care system, and i, too, believe that the affordable care act could do a lot of good here and there, in bits and pieces.  but the more i read about it, the more i realize the affordable care act will not actually make healthcare in this country affordable.  here are a few articles from the new york times i've been looking at recently:

reed Abelson writes, "Say goodbye to that $500 deductible insurance plan and the $20 co-payment for a doctor's office visit."  in an effort to avoid the "cadillac tax" of the affordable care act, a penalty on "luxury" health care plans, many insurance plans are scaling back their offerings.  the author writes, "In a way, the changes are right in line with the administration’s plan: To encourage employers to move away from plans that insulate workers from the cost of care and often lead to excessive procedures and tests, and galvanize employers to try to control ever-increasing medical costs."  but my $20 co-pay isn't a luxury for me - it's what makes going to the doctor affordable.  when the point of health care policy is preventative medicine, accessibility and thus the price of health care has to encourage every american to seek medical help.  no one should be discouraged by the price of an appointment.  preventative medicine starts with absolute accessibility.

certainly, patients may be insulted from seeing cost and subjected to excessive medical procedures, but this has not resulted from the luxury of a low deductible or co-payment.  in this litigious age, doctors themselves have been insulted from the cost of medicine.  they have no idea how much their recommendations, prescriptions, and orders cost.  therefore, they have no way to know or incentive to prescribe more cost-effective evaluation and treatment.

here's another essay i dig: "a simpler, better solution."

usually i don't care much the room for debate forums.  these two doctors (david himmelstein and steffie woolhandler) write an opinion that simple, succinct, and scary.  they first simply argue that a single-payer health care system is more simple and efficient.  done.  then they note several disturbing problems with the affordable care act, which has a lot to do with how complicated the act is.  first, this:

"If your income is below $31,321 for a family of four (133 percent of the poverty line), you will get Medicaid (unless you live in a red state that declined the federal assistance, like Texas or Alabama). And “Medicaid” nowadays means a privately run Medicaid H.M.O. But make one dollar more (or if Junior moves out, leaving a family of three) and Medicaid disappears; now you’re shopping for subsidized private insurance in the state-run exchange. That’s not a rare occurrence: 28 million adults cross the 133 percent line annually."

then they note that if you, "[m]ove from 400 percent of poverty to 401 percent, and individual premiums rise $2,303. Can’t quit smoking? Add $3,365."

the rules and exceptions are labyrinthine.  flatly: the affordable care act is far from comprehensive and does little to make health care affordable to average americans.

mandating that all americans pick up health care is pointless if basic health care is still unaffordable.  we can't argue for preventative medicine, medicine that deals with mole hills before they become mountains, then keep access to that out of reach while patting ourselves on the back for insuring the nation.

i had hoped the affordable care act could be obama's greatest legacy, and he has definitely been a fantastic president, but i think this may just be one of america's greatest disappointments.

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