Carole Milligan: Reason prevailed over fear
April 4, 2010
Thank you to Rep. John Salazar, Sen. Michael Bennet and Sen. Mark Udall for voting for the recently passed health care reform legislation, which begins to address some of the issues of justice in our health care system. As a physician, I have long seen the inequities in the system, which have gotten worse and worse.
Some of these stem from for-profit insurance companies and the way that they view making a profit — they eliminate those who are expensive, such as the sick and those with pre-existing conditions, and they have limits on coverage both annually and lifetime, so those with expensive treatments fall out at the top.
Structurally, we have problems because insurance has been employment-based and has not been portable. If you move or change jobs, you must get different insurance. If you have a pre-existing condition, you are stuck. We have wildly increasing health care costs because of a whole variety of factors resulting in a rationing of health care to those without insurance who cannot afford to pay for the services they could get for a much lower price in other countries.
How is this bill going to help? There has been a lot of heat and a minimal amount of light on the subject.
This bill ensures consumer protections in the insurance market by eliminating lifetime limits, limiting the use of annual limits and preventing companies from dropping people for pre-existing conditions. All of us, regardless of the source of our insurance, will benefit from these changes in the long-term health of our community and in potential decreases in what private insurance holders will be paying as a "hidden premium" for unreimbursed care (currently about $1,100 a family). It means that health insurance will be portable, no longer depending so much on a particular job or location.
In Colorado, there are 826,000 uninsured residents and 345,000 who have individual policies who now will be eligible to get affordable coverage through a health insurance exchange, just like federal government employees already do. In addition, about 440,000 residents could quality for premium tax credits to purchase health coverage; 574,000 seniors would receive free preventive services and 100,000 would have the cost of their brand name drugs in the Medicare Part D "doughnut hole" halved; 68,000 small businesses could be helped by a small business tax credit to make premiums more affordable (currently 77 percent of Colorado's business qualify as small businesses and only 38 percent of them offer health insurance).
Some of the less publicized and less glamorous provisions of the bill include support for long-term home and community-based services to allow seniors and the disabled to stay in their homes as long as possible. This will help the as many as 430,000 Coloradans who are disabled or will be turning 65 in the next 10 years. The bill also will invest in innovations in primary care and provide financial incentives to hospitals to better coordinate the care of Medicare patients discharged from the hospital to reduce readmissions. In Colorado alone, this could potentially prevent 23,000 Medicare re-admissions.
There are also provisions to simplify and standardize paperwork and computerize medical records to reduce the number of hours a physician incurs in their practice (140 hours of physician time and $68,000 a year in employee costs) dealing with the health insurance bureaucracy. To ensure that there are a sufficient number of primary care physicians to take care of patients and coordinate their care, there are financial incentives for the 6,000 primary care physicians in Colorado to reduce the discrepancy in the reimbursement for primary care and specialty practice. And, because there are 460,000 Coloradans who cannot access primary care providers because of shortages in their communities, health care reform will expand and improve programs to increase the number of health care providers, including doctors, nurses and dentists — especially in rural and other underserved areas.
Do I think that this is a perfect bill? No. But I think it is a very good start at moving this country toward a just system of health care. Clearly, the winners are all of us as individuals who want to get appropriate care when we need it, be able to keep our homes in the face of a health care crisis and want our children to be insured so they don't face the kinds of problems we have faced with lack of access. Nobody is coming between you and your insurance company, and no one is coming between you and your doctor to make health care decisions. It is important to try everything we can do to streamline a system that only serves a portion of our population well and so many poorly. I have been frustrated by the long, slow workings of the Congress on this, but I think it is a great step forward. Thank you to everyone in whom reason prevailed over fear.
Carole L. Milligan, M.D., a retired radiation oncologist, is the medical director of the Hospice of Northwest Colorado and co-chairwoman of the Ethics Committee at Yampa Valley Medical Center. She has followed the issues within health care reform from the perspective of practice and ethics for many years.