1st post/Health Care Reform

So here I am, in suburbia, IL not sure what to do with myself. Hence, I start a blog. I'll be writing about pretty much anything that comes to my head, from interesting medically related stuff to Chicago sports to sweet celeb gossip. If it runs through my head, it'll probably end up on this blog in some form or another.

Onto my first post....

Now into my 2nd year of medical student, I'm pretty used to living on an incredibly restricted budget and simultaneously watching my level of debit rise faster than the number of Tiger Woods mistresses coming out of the woodwork. Living in such a way, I find that I'm living in an idyllic world of medical beliefs. I see comprehensive health care for all a necessity, regardless of physician reimbursement (Random Factoid of the Day: Family physicians currently are reimbursed $3 for an office visit for people on Medicaid), cost to the system, etc. While I understand that I am immensely simplifying a complex issue, I think it's unbelievable that people are forced to choose whether they have housing, food, or health care that month. Even more astounding are the number of hoops that people on public aid, etc. must jump through to simply see a doctor. In light of this, since the swearing in of President Obama on January 21st of this year, I have been waiting with baited breath to finally see some action by Congress on such a critical issue.

Today, the Senate passed the first step of health care reform legislation (60-39) in a historic Christmas eve vote (first one in 114 years). While a step in the right direction and getting a lot right (e.g. no pre-existing exclusion to policies), there are 3 major problems with this bill (amongst others like how we are going to pay for all this):

1. No Public Option
This has been one of the major sticking points with the whole health care reform movement. Maybe it's just me, but don't we already have a form of this? It's called Medicare. So, I'm not sure why so many people are in an upheaval about this being some kind of new 'socialist' ideation. Further more, I see a lack of this coming back to bite the government/U.S. citizens in the caboose. By straying from such an option, the Government seems to implicitly be backing the notion of health care co-ops. To briefly explain, these co-ops would basically be a non-for-profit group of people who would self-assemble and negotiate their own rates of payment with physicians. The governmental involvement would be a $6 billion dollar investment in getting these started and then allowing these groups autonomy. Ugh, where to begin. First of all, there would seemingly need to be substantial national or regional organization in order to negotiate even halfway decent rates as compared to private insurance (which is going to be difficult to accomplish). Further, the number of benefits that co-ops would be able to offer its constituency would not be near enough to compete with the large insurance companies. Finally, just look at the track record. While there have been some co-ops that have succeed in Washington (state) and Minnesota, the vast majority have fallen face down like a drunk celebrate trying to argue out of a DUI. Not good. At least a public option would have the organization and resources to push the insurance companies into offering good benefits at competitive rates. Co-ops just won't have enough to force this issue. Damn insurance lobbies are going to screw people out of the best coverage possible.


2. Abortion Clause
As the House attempted to pass their health care bill on Nov. 7th, Rep. Stupak of Michigan threw in an amendment that nearly sank the whole thing. His addition was to exclude coverage for a woman's abortion if they received an federal coverage. In the wake of these actions, Sen. Nelson of Nebraska today attempted to block this provision, once again nearly scuttling months worth of work. In the end, it was decided that women must pay in order to obtain abortion coverage. I understand the fervor over this topic and will try to stay away from the ethics. Nonetheless, an abortion is still a medical procedure performed by doctors and excluding it would be like excluding some other random procedure, say a mole removal. In the case of a mole removal, both are optional procedures, require the removal of alive tissue from the body, and can lead to complications/further issues (**Note: I'm not saying that having a baby is a complication/issue. But being pregnant comes with a whole slew of other risk factors like hypertension, gestational diabetes, etc. Also, there is always a risk of ectopic pregnancy, etc.) I just don't see how you can exclude one procedure without making an argument for excluding others and thereby leading to the whole exclusion problem all over again.

3. Who is Covered?
While the passage of today's legislation helps cover tens of millions of people, what happened to helping those ~150-200 million people currently with employer-supplied insurance that are at risk/currently struggling with extravagant out-of-pocket health care expenses? Well, in short, those people are screwed. Especially since there is little proposed about what alternatives would be available to those who switch jobs or are unemployed. Further, for those who keep their jobs, a new excise tax on employer health plans that are deemed to be 'Cadillac policies' has been proposed. The tax would be imposed on any annual premiums that exceeded $23,000 for family coverage. If this increase is enacted, you'd have to assume that companies would decrease benefits to remain under the $23,000 line. This assumption was backed up by Mercer (a benefits consulting firm) who polled employers and found that 2/3 of the companies polled would do exactly that if the tax is instituted. So basically, by including the tax, we'd be incentivizing profit-fueled companies to provide even less benefits to their employees, and thus require employees to pay more out-of-pocket. If we don't include the tax and leave things how they are, employees are required to pay a lot out-of-pocket. So, we're essentially making a change to change nothing. Great job Congress.

Overall, what I want most out of this is for anyone to be able to go see their doctor when they have a problem and not have to wonder if they are going to be able to pay their rent or for groceries if they do. This is a call to those on the Hill (who have great health care mind you): PLEASE don't forget about anyone of your constituents, be it the uninsured poor man, the middle class woman who pays >25% of her yearly income for health coverage, or the employer trying to give his employees the most he can in terms of health benefits. Helping one and causing another to struggle is not an answer.