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They’re Not Taking Away Our Puppies (And God Help Them If They Do)

September 30, 2013

By Jacob Molyneux, AJN senior editor/blog editor

I am amazed at the amount of time being wasted on the relatively mundane matter of health care exchanges. It seems we are now facing a government shutdown; there are creepy and misleading advertisements funded by conservative billionaires like the Koch brothers in order to scare people from signing up for insurance; some red states have actually enacted laws forbidding the health care navigators from helping people understand the new system and sign up for it, and many of these states have refused to create their own exchanges to help their citizens comply with the new law.

The ACA is a law. You can’t just ignore it if it doesn’t meet your personal preferences or political ideas. Given the heated rhetoric the Republicans are trotting out about it, you’d think the government was trying to take away our puppies, instead of implementing ideas originally floated by Republicans themselves to make life a bit easier for millions of Americans whose life decisions are unduly ruled by crazy health care billing practices, byzantine insurance regulations, discrimination against those who have chronic conditions, insanely varying pricing for simple tests, and the like.

Short detour into personal history: when I was 26 (i.e., 20 years ago), I quit my job running a classroom for abused and neglected toddlers in Boston and headed to North Carolina for graduate school. When I enrolled in grad school, I opted out of the health insurance option, thinking quite naturally that I’d like to save myself money. I also opted out of COBRA, a pretty expensive way I could have continued the coverage I’d had from my former job for six months or a year. That fall, I lost a ton of weight and nearly ended up in a coma before finally getting diagnosed with type 1 diabetes, my body having attacked itself in an act of supreme autoimmune confusion and wiped out all my insulin-producing cells. My lack of insurance was a serious source of stress for a number of years, as the supplies I needed just to test my sugar regularly and take insulin cost a lot of money, and buying affordable insurance on the open market with a preexisting condition was basically impossible. In such an America, many of my career choices ended up being heavily influenced by the need for employer-sponsored insurance, which I now blessedly have through my job.

The Affordable Care Act (ACA)—I do not accept the politically charged name Obamacare, and fail to see why journalists have consented to use it, or why the Obama administration has even done so in many cases—is not out to get anyone. It’s simply an attempt to bring a little order and regulation to a system that has become untenable, inaccessible to many millions, inefficient, and deeply inequitable. As everyone knows, the ACA was enacted against stiff opposition from industry and multiple conservative groups. This means it’s not as good as it could be; it could be improved, and probably will be once we stop wasting time trying to fend off those who simply want it to fail.

The health care exchanges (about to go into effect) are not at root a complex idea: they are about offering a menu that meets certain standards of honesty and transparency, one that is intended to help people who don’t currently have health insurance purchase plans that fit their financial realities and their health care needs. It’s that simple. If some sites turn out to be better designed than others, this is something that can be worked on and improved.

There is a health care exchange in Massachusetts that works just fine. I spent a bunch of time investigating it a couple of years ago when I edited an article about it. There are gold, silver, and bronze plans on offer; each category has to meet certain minimum standards about things like deductibles, copays, out-of-pocket limits and costs, etc.

It’s complex, but a lot less so than the system it replaced. Even the conservative politicians in that state mostly want to keep the health care system often referred to as “Romneycare.” It’s not perfect, with funding being a real issue, and a lack of sufficient numbers of primary care providers a problem in some areas, but there’s a general sense one gets that the focus is on improving the system already in place rather than subverting it or removing it. No one really wants to go back to the entirely disorderly and market-driven system that afflicts most of this country. (Okay, maybe a few rich people do, as they can always buy the best health care in any system, whether or not they are insured or not.)

This isn’t at baseline about Obama; it’s about the American people. And it’s called the Affordable Care Act for a reason, even if we still have a long way to go toward true affordability for many of us.

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9 comments

  1. I agree with DC. Being a nurse and working in a hospital, one has a very special place in their heart to want to help everyone. But, realistically and mathematically it’s impossible. ACA is not a feasibly sustainable business model, and unfortunately people don’t see the big picture. Hospitals will feel the financial hit in the next 5 years and this is where people will start feeling the economic down fall of this whole ACA mess.

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  2. Hospitals are concerned about going out of business due to the Affordable Care Act. That might be why Republicans and many other are unhappy and “negative nillies.” The reimbursement for care being paid to hospital (for those of you who work in hospitals) is set to be cut in half over the next 5 years or so with this law. So hospitals are cutting staff and costs. Your job may be in jeopardy thanks to the ACA. I know that our hospital is having layoffs for the first time ever to prepare for the cuts in reimbursement. So as the country struggles to pay for all the new people being covered by this law it cuts reimbursement for the care that will be provided. It seems pretty clear to anyone who can do math that this will not work. We all want coverage for all. But who will pay? The national debt ceiling is not a ceiling. It is a constantly moving number. So we keep wanting more, spending more, expecting more, and expecting our taxes to stay the same. Not sure how it works in your household but that will not work in mine. If no more income comes in I cannot afford to spend more. Perhaps our country needs to learn that as well. I may want to feed the world but if I only make $50,000 a year I am limited in what I can. In order for coverage for preexisting conditions millions who will not use their coverage have to be enrolled and pay premiums and not use any services. That is the reason that everyone is required to enroll or to show proof of insurance. It is simple economics. There is no other “insurance” that exists to have people pay money to ensure that they receive more benefit than they pay in every year. We do not pay car insurance to make sure that someone pays car costs every year. We do not pay life insurance to make sure that we get benefits paid every year. We pay for those rare cases that something happens and we need a payout. And from the pool of those paying some payouts are made. For those with preexisting conditions the expectation is that they pay a small amount and are guaranteed that they receive payment of large bills. Where else in life does that work? As the mother of a child with a significant medical condition I do not know the answer but I know that I pay thousands of dollars a year in medical costs for his care and surgeries. But I do not expect that I should pay $8,000 a year in insurance costs and expect to receive $50,000 a year in benefits. It simply is not a sustainable business model. As nurses we need to stop reacting with emotions and consider all factors, appreciate all sides to the issue, and contribute to solutions. Finances matter, not just a desire to help all.

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  3. I guess I just don’t understand how Republicans can have such a lack of compassion for their fellow man. So many people have latched on to key phrases about the Affordable Healthcare Act spewed by the negative nillies and they don’t actually spend much time reading about the facts. Then when they do they don’t believe facts!!! Obama was elected President and I believe and other Democrats will stand by the law. I find it so difficult to talk to anyone opposed to the law. They are convinced their taxes are going up and that physicians offices are going to close. Sometimes I think those are the same type of people who cannot handle change. My son is on disability, I have him on my insurance, and he still has to pay what is left of physician’s bills. It does not seem right.

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  4. Great post. As another commenter noted, I too have lived in a country in which I had private (yet affordable – $60 a month) insurance as well as a public option. I experienced care with both of these options and it was equal to or better than the care I have received here. My parents, small business owners who have to purchase their own insurance, have long been paying astronomical fees for the absolute minimum insurance coverage, often foregoing crucial medical appointments, needed prescriptions, and treatments due to the dire coverage and high deductibles. I hope now that they have another option, they will get the care they need.

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  5. The fact underlying the opinions in this blog post are well known, so it didn’t seem necessary to include them. But maybe they are worth noting: today, for the first time in my lifetime, as a result of the ACA, people with preexisting conditions (that’s 85 million Americans) cannot be denied health insurance coverage in the U.S. This is a fact having nothing to do with politics, as are the 40 million plus people in the U.S. without health insurance, and the troubling statistics on the frequency of medical bankruptcy for people both relatively well off and the poor, and so on. You can debate how to deal with these pressing issues, but the facts are pretty clear. Any real engagement with these issues means the consideration of viable solutions. This is what the ACA was designed to be, however imperfect it may be.

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  6. Thanks for the feedback so far! There are bound to be some serious glitches in the coming weeks; much energy that could have gone into making this better and explaining it more clearly to people have instead gone to fruitless rhetorical battles. I don’t see this as an inherently poltical issue, as a couple commenters on our Facebook page seem to, though it has certainly been politicized.-Jacob

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  7. People forget that our existing state of health care distribution is hemorrhaging. It can’t last. With the ACA, an estimated 25 million more people in the US will have health care. What’s wrong with that?

    If I got a nickel every time I heard someone say, “Protecting my health IS my health insurance,” it still wouldn’t be enough money to pay for all the treatments administered annually to uninsured adults who never smoked, over indulged, and still get sick or injured. Some get treatment, (some do not) and it costs everyone a whole lot more money the way we do it now.

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  8. This is excellent. No one can really identify what it is like to be denied healthcare unless they have lived it or seen their patients live through it. The term Obamacare was just a copy of its model Romneycare, first as an insult, then adopted by supporters. As the President just joked, “if this turns out to be great, they won’t call it Obamacare.”
    The law’s name is the Patient Protection and Affordable Care Act. Its name is its purpose: protect patients from the abuses of big insurance and make it affordable. If only Jefferson had added healthcare to life, liberty and the pursuit of happiness, maybe we Americans would not have taken over 237 years to realize that healthcare is a human right. Let’s stop the horrible politics and start making it work.

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  9. Thanks Jacob, I agree! After living in Australia for 2 years and seeing a healthcare system work quite well with a combination of public and private options, I hope the US will someday have a something similar. I wrote a blog that AJN published a couple years ago about this and my thoughts have not changed. Also, my Aussie friends cannot understand Americans fighting this opportunity. Their strong opinions are the biggest reason I believe we need the ACA and hopefully a public option someday.

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