Wednesday, August 26, 2009


I drafted an Op/Ed a couple of weeks ago, in hopes that our local paper might pick it up. No word thus far, so I'm posting it here.


For some weeks now we have been subjected to the sound and the fury thrown forward by the opponents of the White House and Congress’ efforts to enact health insurance reform. Misrepresentations and outright untruths have been trumpeted by those who would block health insurance reform. This is a shame, as our current health insurance system is terribly broken and this is our best chance to fix it. In a system where 1/6 of the nation lacks health insurance coverage and health care costs are expected to rise from 16% of our GDP to 25% in 2025, the system is in terrible shape.

To date, I have practiced only in communities where access to health insurance was difficult and insurance issues were common. I have had to work with patients to determine which of their $4 prescriptions were most important, as they could only afford to fill one of them. I have had patients ask me to do only the barest of essential tests and procedures and to wait (if possible) until Medicare kicked in before doing preventive and health maintenance care. Patients delay valuable and necessary care because of cost and lack of insurance coverage. Meanwhile, for-profit insurance companies make enormous profits while working to deny care to patients who have paid for their insurance as well as rationing health care services. Small businesses (and large corporations) are unable to invest in growth because they are hamstrung by the ever-increasing costs of health care insurance for their employees. Even those households with insurance face a choice to pay higher premiums or switch to cheaper plans with less coverage. On the world stage, our health care system ranks first in terms of how much money we spend, but only 37th in overall performance (World Health Organization rankings).

The current health insurance system has not answered these challenges. Studies have shown that patients who actively look to purchase health insurance are unable to do so 75% of the time due to cost or pre-existing conditions. Public health insurance plans—such as Medicare and Medicaid—are burdened with covering those patients with the greatest needs (elderly, disabled, children) as private insurance plans cover a disproportionately large proportion of young, healthy patients who need less health care per person. 50% of personal bankruptcies in the United States are the result of health care costs, and most of these patients had insurance when they first got sick. This is no way to care for our nation’s citizens.

For the first time, business, government and health care organizations have joined to support health insurance reform. This reform must accomplish key goals: it must be universal, affordable (for patients and for the country) and accessible to all. For-profit health insurance plans have not been the answer, and coupling a high-deductible insurance plan to a health savings account would leave too many people uncovered. The only true path to reform is to develop a public health insurance plan option. This public health insurance plan would set a standard for costs, coverage and access that for-profit plans would have to answer. This would work to make coverage more available for all. Current legislation—thus far endorsed by such groups as the American Academy of Family Physicians, the American Medical Association, the American Academy of Pediatrics, the American College of Physicians, the American College of Surgeons, and many others—proposes such a plan while preserving patient choice of health care plans and physicians. This legislation also would enact deeper reforms that would promote preventive care and health maintenance services, enhance primary care training (as you cannot have an efficient health care system that is not founded on the bases of solid primary care), make for-profit health insurance plans more accountable to their patients, and ease the costs burdens on small businesses.

As a country, this is our chance and our opportunity to change a system that is flawed and failing. Enough shouting and enough lying. The current legislation is supported by a breadth of health care professional organizations and numerous other stakeholders. This is the time to act decisively. The next few months will dictate healthcare in this country for the next 15 or 20 years. If we fix it, then the nation will benefit. If we don’t, more and more people will be lost to the system. Congress needs to pass comprehensive, meaningful health insurance reform now.


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