Obamacare hits 7.1 million: Good News and Bad News

southcentral foundation alaska

The basic premise is that the more people who have health insurance the better. There are a lot of reasons for this, but to note a few:

(a) Reduces personal bankruptcy: Even during the worst recession since the Great Depression, more personal bankruptcy were due to medical care than any other financial factor. More than housing, more than personal debt, more than credit cards, more than student loans. When someone declares bankruptcy not only does the hospital and doctor not get paid, nor does any who are owed money. When someone loses their home after a medical illness it is misery on top of misery.

(b) It is a public health issue: People who have health insurance see their doctors, thus we can determine if influenza is on the rise in a state, if there is an outbreak of tuberculosis, measles, and provide early treatment. Knowing if there is an infectious disease and being able to find its source can protect the public against bad food (such as when they discover a bad lot of beef, or spinach). It alert when there is a bad source of water, or if more people are coming in because of air pollution.This ultimately saves total public health costs.

(c) It reduces healthcare dollars: When people seek healthcare early in their disease course it costs less than when they seek it later. Early treatment of pneumonia can be done with oral antibiotics out of the hospital, but if a person does not have health insurance and does not seek help they end up in the hospital with pneumonia and the cost goes up a thousand fold. Early detection of breast cancer is less costly than later detection when it costs tens of thousands of dollars for chemotherapy. Early detection of colon cancer with colonoscopy and removal of polyps cost much less than late detection of colon cancer with invasive surgery and chemotherapy.

Here is the silliest argument made against expanding healthcare insurance:

The physician shortage means physicians will not be able to handle the increased load.

People still get sick, whether they have insurance or not. That we have a physician shortage is not going to be made worse now that they have insurance. In fact, it may be made better. Since people with insurance seek out health care earlier in the course of their disease it will unburden some physicians.

The physician shortage is critical and needs to be addressed. The cost of medical school is very high, and we need more doctors, especially in rural areas. This can be addressed by increasing public health service scholarships for those who are willing to serve in those areas for a period of time (typically one year medical school for one year of working in the rural or urban-under served area). That way the physician is not overburdened with hundreds of thousands of dollars of debt, and can develop a relationship with their community and will not feel the financial need to change locations.

Here is the second silliest argument made against expanding healthcare insurance:

Physicians will not take Obama-care
Whether a physician chooses to take an insurance plan or not is up to the physician and has more to do with the economics of the insurance policy than the politics of the insurance policy. If the insurance policy provides a reasonable reimbursement for the provider they will generally take the policy, if it does not then less will take it. But the person is still insured, they still have coverage to go to an emergency room , find a new primary care provider if they must, and be covered. There are clearly those physicians who will not take an insurance policy for political reasons. One recent article quoted 70 per cent of doctors, however they were internally polling among their group of described “right wing Republican doctors.”

Health care inflation is a real problem
The cost of healthcare in the United States has been rising for years at double and sometimes triple the cost of inflation. Part of this is due to new technology, some of which is overused. Part of this is due to drug companies. This cost has been hidden from most people who are getting their healthcare policy from their employer, but have had increasing deductibles.  

My hospital is now requiring patients pay their deductible up front before they are admitted for elective surgery – and for some people this is thousands of dollars. This is not the new result of Obama-care, this is a result of runaway health care costs.  It is not the result of greedy doctors, most of whose reimbursements have not kept pace with inflation. When my wife was pregnant and we went to the hospital the first thing they did was ask for our deductible, which was $3000.00 – my son is worth that, but it is a lot of cash to come up with for anyone.

Some like to blame lawyers (Shakespeare’s idea to first hang the lawyers appeals to many doctors) – because of increasing malpractice claims and the use of defense medicine. Defensive medicine is where doctors will order even more tests for patients because they fear a sick patient may sue them if they didn’t order them all, or want to be able to say in a courtroom they ordered everything, even though a reasonable physician would never order all of those tests. Tort reform is needed, although unlikely to occur at the Federal level. While Republicans say they are for reducing or capping limits on malpractice, even when the GOP had a majority in the House, Senate, and the President of the US – there was no tort reform, and the leader of the Senate majority was a cardiac physician who bluntly told people that tort reform would never happen.  Tort reform will need to happen state-by-state and jury-by-jury.  Lawyers who sue doctors make their living by getting a per cent of a large verdict. There is no ability for doctors to settle “nuisance” lawsuits without getting penalized — every hospital and medical board is notified, investigates, and may affect if a doctor can take insurance or not.  Some states are worse than others for medical malpractice — Mississippi being one, some states have instituted caps and are better, such as California and Texas. If there was the ability to settle some of those lawsuits without reporting or penalty it would relieve some of the burden (currently the limit is $10,000). Major companies do this all the time- settling to avoid the cost of litigation, which is often the major cost of healthcare. Physicians typically spend 20 per cent of their revenue on malpractice insurance, some specialties even more.

What Obama-Care Didn’t Cover
Having everyone insured is an ideal that any reasonable person would want. But universal coverage is not the answer to all healthcare issues.  Nor is the key the “outcomes” of care, where hospitals are penalized if they have a complication from a complicated patient (such as a wound infection after surgery – that happens in spite of the best of care). Universal care was given through the Indian Health Service, and yet most Native Americans (I am one, and I worked in the system for several years) would argue it is ok but wasn’t great and overly bureaucratic – everything the opposition to Obama-care says it is.

What is a key is the relationship building between the doctor and the patient. No one is paying for this, and yet this is what drives down costs and ER visits faster than everyone.  The model healthcare for this is in Alaska, at SouthCentral Foundation – who have driven down healthcare costs by developing relationships. This model is sought after by different countries around the world. Think of it: the patients have no deductible to meet, no co-pay, get over-the-counter medications from the pharmacy for free, and yet they use the hospital less than any. Same day access to primary care, a Fast-Track in the hospital ER, and decreased admissions for: childhood asthma, childhood pneumonia, diabetic issues, and pain issues. You can read more about SouthCentral in several articles on this blog.

I’ve written on these topics previously; relationships and healthcare, my personal experience with SouthCentral Foundation’s health care delivery system, and a formula for cutting healthcare costs.
We are in a new era.  It is sad that the GOP persists in their single focus to rid Obama-Care while not working to fine tune it to bring all health care costs to the table. To state that they were excluded when it was passed and therefore they won’t work with the democrats is what we would expect from a grammar school playground. Were bi-partisan work done for healthcare reform, it would benefit both parties, but more importantly, it would benefit the US. It is clear some on both sides wish to fine-tune and instead of the shrill noise of “get rid of it” or “it is the best” – there is a clear answer: we have just begun, and we are a long way from it, and what we had before didn’t work and it cost too much.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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