Monday, March 22, 2010

Healthcare Reform

Well, it passed! John and I watched C-Span for longer than I'd like to admit to you, watching debate (much of it silly parliamentary stuff, along with enough rabbling to evoke the British Parliament at work), and I nearly cried when the bill finally passed. Tears of joy, that is.

My lovely readers obviously know where I stand on the bill. It's not perfect, it's not far-reaching enough, and it really only addresses the insurance side of the equation (and not topics like tort reform). It's not so much healthcare reform as it is insurance reform. So why is it important to me? Because in this case, insurance reform means reform of disparities of access to healthcare. And in this sense, insurance reform IS healthcare reform to many people, like the 32 million who will now have access to health insurance, and thus, access to healthcare beyond emergency rooms.

And yes, this bill does benefit my family. Becca can no longer be denied coverage because she is, as a friend wrote, "a walking pre-existing condition." (Okay, for now she's just a cruising and crawling pre-existing condition, but you get the point.) And when the full plan goes into effect in 2014, I will no longer be denied coverage for my pre-existing condition (almost dying in pregnancy). Becca won't be kicked off her plan when she reaches her $2,000,000 lifetime cap (remember, she's halfway there already). Eventually (assuming we don't have a massive increase in our family's income), we will receive subsidies to pay for our health insurance (because we make less than $88,000). And, diagnosed worrier that I am, I don't have to worry about how we will pay for treatment if one of us is in a terrible accident or is diagnosed with cancer. I just have to worry about everything else that goes along with those awful occurrences.

But that's not really why I am so excited about this bill. Our family would get by. We have a great support system, and while we are not rich, we manage and would continue to do so. I am excited about this bill because in many ways (not necessarily every way), the ends that it is seeking to achieve are simply right. I know that is a somewhat rude thing to say in this climate of partisan vitriol. I do try to respect and listen to all reasoned and factually correct positions on the issue. But this is where I come down on it: it is simply unjust that people in the U.S., the wealthiest nation in the entire world, cannot go see a doctor when they are sick because they cannot afford it. That is simply wrong. It is flat-out wrong that people who have paid their premiums for years are dropped by their insurance when they get sick. It is flat-out wrong that kids born into this country with a medical condition (be it prematurity or asthma) are denied coverage (and remember, coverage = access to care).

I know this bill isn't good news for everyone. Some of my friends who work in higher-paying industries will see some additional taxes (individuals making more than $200,000 and families making more than $250,000, I believe). Theoretically, I guess, insurance companies may see lower profits, even though they will increase their customer base tremendously, because the bill includes a minimum of revenue that must be spent on actual services to enrollees. And larger companies would face fines if they don't provide insurance to their employees. Folks who are on employer-provided insurance may see premiums raised, but, seriously, have you seen how much they are being hiked anyway? When in full force, the bill will limit these premium increases.

I don't know enough about physician billing to fully understand how it will affect our friendly doctors (and trust me, I want to keep doctors happy - we looooove doctors at our house!), but I do know that there are incentives for new medical grads to go into primary care, which is by far the lowest paid area of medicine. (Seriously, I see a lot of doctors and a lot of EOB's, and our wonderful pediatrician bills at a fraction of the cost of the specialists...but she's our go-to and the one holding all the care together. Seems backwards. Plus, she's awesome and reads this blog, and now I'm just plain kissing up. But she is awesome.) I realize that specialists usually have additional training years, but really, the pay difference is so great that we have a primary care physician shortage in our these incentives are a good thing.

I don't think I'm close-minded. I know that it is very much possible for you to agree with the ends that I see as justice (that is, helping everyone in our country to have access to quality healthcare) and still not see this bill as the appropriate means to this end. And, again, I don't think it's perfect. Not even close. But frankly, I no longer expect perfection out of Washington. I'm not sure why I ever did. Our senators and representatives are just human, after all. And in a messed-up two-party political system. But it's what we've got, and I've learned that you've got to do what you can with what you've got (while trying to make improvements) instead of holding out for perfect. So it's a start. And I think it's a big step in the right direction. Time will tell - and I think that's an another important point.

There are lots of folks on every side of the issue making projections about what will be wonderful and what will be horrendous about the bill, but the truth is, we never know exactly how a piece of legislation this complex is going to play out. And I don't think that is a fault of the bill. I'm just saying that we can't predict the future. Make projections, yes. And that's very important. But I think that maybe we should all take a deep breath before we run for the hills. Let's see how it goes. And, in the meantime, let's celebrate the parts of the bill that I think we can all agree on: more kids will be able to get more care. Families fighting cancer won't have to declare bankruptcy to pay off medical bills. And grieving families of a terminal patient won't get a rescission letter from their insurer. (And yes, I do have a friend who's husband was dropped while he waited for a heart transplant. Wow.)

There. I've had my say. I'm happy about this bill, and I hope you are, too. I would love to hear what you have to say about it, but please, please, please be kind and check your facts before you comment. I have a habit of deleting comments that are not respectful or are blatantly inaccurate. Let's see if we can all play nice. And if you want to learn more about the bill from some relatively balanced and unbiased sources, check out these links.


  1. It is a relief to know that if I lose my group coverage that I will be able to get private coverage for Eliza. Eliza's lifetime total is approaching $3,000,000. Our current policy has an unlimited lifetime cap, but we have paid dearly for that in high premiums. Hopefully we can continue the same coverage and not be surcharged for choosing the unlimited lifetime cap.

    The bill may not be perfect, but it sure goes a long way to creating a more just system of healthcare coverage.

  2. This isn't about the bill, but about primary care docs. I think getting more new doctors into primary care would be wonderful. Our awesome, amazing, Superdoc (the one who Vanderbilt Children's Infectious Diseases docs credited with saving Parker last Summer when he had Ehrlichiosis because he's just that Super) is not going to be seeing our new baby. Superdoc is board certified in Internal Medicine and Pediatrics, so he sees everyone in the family from my husband's grandmother all the way down to Parker. Well, he can't find enough call coverage for his peds patients, so he isn't taking any new peds at all. At. All. (Not even his current patients' baby-brother-on-the-way, even though I practically begged with sackcloth, ashes, and wailing and gnashing of teeth recently.) It's easier for him to reciprocate with doctors who don't see any peds for call coverage. So now I have to find a new doctor for Simon. *sigh*

  3. Val, that's sad! But I love Simon's name.

  4. Bravo for your "rude" statement about right and wrong! A Christian blogger that I love wrote yesterday about how there is no "Christian position" on health care. She was mainly talking about how our Christ-likeness shows in avoiding the vitriol of the current debates and speaking kindly, but I had to disagree when it came down to it.

    I admit that I am not knowledgeable enough to analyze how well this specific bill will meet its admirable goals, but overall, (IMO) I think there is a Christian position and it is whatever will help the poor, sick, and suffering, whatever the cost to me personally. Rejecting something that will help others because it will cost ME more or increase MY wait times is self-centered and (again, IMO) not what Jesus would do.

    And religion aside, whatever happened to concern for "the common good"?

  5. Thank you! We're big "family tree" name people. Simon was our kids' 6th-great grandfather's first name. His middle name is Val, which was my daddy's middle name, and Daddy was named after HIS daddy, Valter. Simon will be the 4th generation with a "Val" name.

  6. I posted an update on FB that said, "Would you deny for others what you demand for yourself," which is from a U2 song.

    You would not believe the "stuff" people said about how they work for what they get and the bill infringes on their rights. Or maybe you would believe it.

    I do not practice any religion (I was brought up Catholic), but I know that it is right to care for others---the poor, underserved, children. And I also know that many of the people who cannot get insurance or have inadequate insurance are people who work.

    I am just so thankful to read from someone else who believes it is the right thing to do, whatever flaws there may be in it. I don't think I can stomach any more negativity and statements that the US is becoming a Muslim country (yeah, I don't get that either).

  7. Okay.
    Reading your (and some other blogs that I follow.) blogs, it looks to me that the biggest BIGGEST problems are: coverage denial b/c of pre-existing conditions, $$$ caps, and dropping as soon as illness strikes. (Please correct me if I'm wrong) But, if those are the biggest problems, is a COMPLETE OVERHAUL really necessary? Is there not some way to fix at least some of the problems without just bulldozing the original system over?

    That's what I don't get.

  8. Good thoughts, Em. I think it's important to note, though, that the bill really isn't a complete overhaul. That's what those on the far left (probably counting me on this issue) would have liked to have seen, and that's what the original proposals were for - a "single payer system," meaning that everyone would be on a government-run plan. That idea scared the bejesus out of a lot of people and was pretty quickly discarded. The new laws let the insurance companies stick around and maintains the free market approach to healthcare (which I, personally, think is inherently unjust. But that's another issue, really.). So this is the middle road, even though none of the politicians want to say that because it will make their "base" (staunch Repubs and staunch Dems) upset. At least, that's my take on it.

  9. So just where exactly in the middle are we anyway?

  10. Sorry, but I have to disagree. I think it's just as likely that God is wondering why we've decided--well, not we, but 535 people or so have decided-- that as his hands and feet we no longer need to take care of people, we'll just let the government do it for us. God calls us to take care of people but I don't recall him saying the government is how to do it. We (the collective we) are saying that we should rely on government and not God.

    I'm totally for some of the measures Nancy that you are excited about like eliminating caps and pre-ex conditions but the rest of it is really pretty wrong, in a lot of ways, not least of which how they achieved passage of this bill.

    I also think that access (and this is just a fundamental difference of opinion and why I'm not providing links) is better achieved through regulation in a free market than through such vast government intervention.

    And the fact that they left out tort reform is nothing short of hypocritical, not to mention the fact that they completely turned 180 on their promise for transparency. Did you see any ads from the insurance or pharma fighting this bill? No, because they all made dirty deals behind closed doors with Pelosi, Obama and Reid. They will make out fine because they will just pass on their costs. They won't eat them.

    But as you know I'm psyched Becca and you will not be denied!

  11. Emily, I don't really understand your question. Who are the we you mean? I think the "fun visual" link I suggested might help.

    Nat, I hear what you are saying. I really do. And that distinction is why I know that very loving people of deep faith can still be Republicans (like you). :) Lord knows that I think we should be helping each other out regardless of what the government does. But I think it's important to remember that in a democracy, government is one of the means that we have to meet the needs of others. I am all for the separation of church and state (boy, am I!), but I am not for the separation of faith and politics - because if we separate out our faith life from our political life, we shortchange both our faith and our politics. How you understand your relationship with your Creator inevitably orders how you understand your relationship with the rest of humanity, and our government is essentially are organizing of the humanity in this corner of the world. So why shouldn't it tackle the humanitarian needs out there? I don't think we should look to it to eradicate or solve the ills of society, but as the organizing principle of our society, it should address them. And the reality is that we've been trying do healthcare without serious government intervention for years, and it's not working. Millions of people don't get to see doctors. Kids like Becca get scr#$ed. And my friend's community health clinic that relies largely on private donations? It's in serious financial trouble. So, yeah, I'd love for us to act individually and meet the needs, but we're not. And I think that we have a better chance of doing so if we act collectively. And that's what government is - it's the citizenry acting collectively, not some alien entity that descended upon D.C. I don't by any means think that these new laws excuse us from individually working towards equitable access to healthcare for all...but it will help.

    Wow, I'm a Democrat. Go big gov! :)