When a Doctor Became Sick

First Published: May 11, 2017
Minor correction: May 11, 2017
Shortlink: http://wp.me/piQ2P-eY

I can’t get this incident out of my head. Maybe writing about it will free me. Thirty or so years ago, I saw a Dermatologist who was recovering from a major heart attack. He made a point of telling me how shocked and displeased he was that being treated for an illness like that was so expensive. That’s the bare memory. Here are some thoughts and comments.

I can’t remember exactly when this was; I think it must have been in the early 1980s. Ronald Reagan was probably the president. Obamacare wasn’t even a dream and neither was the failed Clinton health care plan, known officially as the Health Security Act and unofficially nicknamed “Hillarycare”. If you encountered a major illness in those days, there were several options. You could have been virtuous  enough to have accumulated enough money to pay the bill. You could be an older person, as I am now, and rely on Medicare. You could have been prudent enough to have employment which provided a solid health care policy, as was my situation then. (Insurance did not actually guarantee coverage because many policies, especially those purchased privately by individuals, precluded payment for “prior conditions”.) You could, after having depleted whatever resources you had, apply for public assistance. You could go bankrupt after running up a big bill. You could consider dying.

Recently, after a lot of debate and maneuvering, the House of Representatives passed the American Health Care Act or AHCA, intended to “repeal and replace” the Patient Protection and Affordable Care Act or ACA, often referred to as failed Obamacare. In 2009, before Obamacare became law, I wrote in a blog post that 50 million people were said to lack health insurance. Various numbers have been cited for the number who gained coverage under Obamacare, but I never saw one as high as 50 million. It has been claimed that 20 million would lose coverage if the ACHA in its present form becomes law. It is difficult to be sure exactly what the effect of this law would be. (Who knew health care is so complicated?) The bill now moves to the Senate. Some folks believe the Senate should and will act quickly to pass the bill as sent over by the House; some do not; quite a few Senators, both Democrats and Republicans, say the Senate will perform its own deliberations, wait for some numbers from the Congressional Budget Office, and produce its own bill, necessitating a process to reconcile the House and Senate versions. Douglas Turner, one of my favored columnists suggests this will take until July. Meanwhile, insurance companies are presently required to submit their ACA based plans and rates for 2018 by early June. Maybe that deadline will change. It’s possible that, as a result of the delay and confusion, many insurance companies will bail out, driving a stake through the heart of the already flailing Obamacare.

There is currently and has been a lot of discussion and debate about all this. How good is the AHCA? How bad is the ACA?

As I’ve already noted, it’s difficult to say with certainty, but it does appear that the AHCA, as passed by the House,  does save money and make conservatives happy by restricting benefits.

Many opponents of Obamacare say that it just costs too much money and is responsible for the massive increases we’ve been seeing in health care costs. (It is well established that we spend more and receive less than most so-called “advanced” countries. President Trump is reported to have recently told the Australian  Prime Minister the Aussie plan, single payer and government managed, is better than ours. He did also say that our system will soon be greatly improved.) I am not going to claim that the ACA is not responsible for any increase in costs. I do claim that it is not the only factor.  A recent People’s Pharmacy Column claims that a powerful drug lobby is responsible for costs as high as $750,000.00 per year for some so-called “orphan drugs”. Drug and medical pricing is clearly an area where the workings of the market do not match the supply and demand laws explained in economics textbooks. Elisabeth Rosenthal’s recent book, An American Sickness, casts a lot of blame on unethical and even dishonest practices by doctors and hospitals.

When I asked a conservative Facebook friend and debating partner to provide some backing for his claim that Obamacare has increased medical costs, he sent me links to a couple pages. An article on the US Chamber of Commerce site states that “Obamacare’s Devastating Medical Device Tax Killed 28,000 Jobs”.  “The tax went into effect in 2013 but was suspended in December 2015.” The chart accompanying the article indicates that the number of Medtech jobs did indeed drop in 2014 and picked up a bit in 2015. It does not show numbers for 2016. I did a little searching and found nothing. The article does not claim this caused an increase in medical expenditures. An article in Forbes states, “The ‘Cadillac Tax’ Will Drive Healthcare Costs Higher For The Middle Class.” Here are a couple quotes. “This excise tax was intended to encourage employers to eliminate overly rich healthcare benefits that could lead to excessive, inappropriate utilization of healthcare services and unnecessary healthcare spending. In addition, the revenue from the tax was to serve as a funding source for a portion of the ACA’s insurance subsidies.” “Instead of impacting unnecessary care, the Cadillac tax as currently structured will increase hardship for a growing number of Americans with severe and chronic illnesses. And its salutatory impact on healthcare spending will be minimal at best.” It appears the tax does create additional expenses for some individuals, but the article doesn’t show or claim it increases our overall health care costs. Then they go on to address the shocking increase in the costs of medications. They do not claim the ACA has caused this; they do criticize it for failing to control these outrageous costs.  Neither of these has convinced me that Obama and Obamacare are responsible for the cost increases we’ve seen in recent years.

It can be claimed that by providing more people with more access to health care, the ACA has increased the demand for medical services and supplies with the result that costs have gone up. The counter claim would be that when people see a doctor sooner, they obtain preventative care sooner and don’t end up in expensive emergency rooms and hospitals. I have yet to see any solid numbers about this. If anyone has them, please share them with me.

I’d like to be able to provide a detailed and accurate analysis of this, but I’ve yet to figure out how to do a thorough job of research. (I repeat myself. Who knew health care is so complicated?) It remains disturbing to hear people say that we who consider our country one of the best and richest cannot afford to provide all of the populace with solid health care.

Many conservatives oppose universal health care and government involvement on philosophical and moral grounds. Some say that providing health care should and must be a function of the private sector, not of the government. I can agree that the government should only be involved in things that cannot be done efficiently and effectively by the private sector. I’ve already noted that supply and demand don’t seem to work well in providing health care. It makes perfect business sense for an insurance company to charge extra or deny coverage for preexisting conditions. It also makes perfect business sense for a pharmaceutical company to charge as much as the market will bear.  Show me a way to provide affordable health care for everyone without government intervention and I’m all for it.

Others decry affording “handouts” to those who have not been prudent and hard working enough to be able to take care of themselves.  Handouts? Well. While I’m not a big practitioner of many of the details of religions, I am a great fan of Christianity as professed by Pope Francis. In the encyclical, Laudato Si, he essentially says that since we are all connected, we should take better care of each other and our common home. I want to make a point of adding something here. In accord with Catholic teaching on social justice, he mentions two principles: the first is that all people deserve the opportunity to express their human dignity by earning a decent living; the second is that those who, for whatever reason, have become unable to help themselves must be helped. (In a recent Ted talk, Francis referred to the story of the Good Samaritan.)

Part of the problem is that we keep framing this as a discussion about providing insurance when we should be talking about providing health care. At this point, I think I’ve rambled on long enough. If you are still with me, thanks for listening.

©Charlie Wertz May 2017