The government is like our mom.
Hear me out.
Remember how embarrassing it was when she dropped your lunch off at school? And she packed it in your second grade Ninja Turtle lunchbox? How dare she? But at the same time, she packed your lunch, didn’t she? She brought it to school when you forgot it, didn’t she?
Yes, the U.S. government is like our mom. In many cases, it is damned if it does and damned if it doesn’t; the Affordable Care Act (ACA) has been no different.
Before we can dismantle the ACA, I want to help patients understand the role government has played in American citizens’ health throughout history. I have so many patients come in that don’t realize their current plan actually hurts them more than benefits them. Healthcare is a private subject, however privatized coverage needs to be exposed.
The Years Leading Up To the ACA:
Theodore Roosevelt was one of the first presidents to want universal healthcare. In 1915, a bill was passed for health insurance to cover only the low working class and their dependents. The American Medical Association (AMA) was in support of the bill after being consulted for its design.
However the opposition came from labor unions, private insurance companies, and state governments for this “socialist” agenda. The bill was halted.
Universal healthcare had largely been untouched until Truman was in office in 1945. Truman believed, apart from Roosevelt, that insurance should be for everyone and not just reserved to a working class of a limited income. However, very reminiscent of today’s Affordable Care Act, doctors of the AMA claimed it would make them “slaves” despite Truman insisting they could design their own form of billing and payment.
As a primary physician, I understand this argument. Doctors have a responsibility to treat with quality not treat by the quantity. Most general physicians visit with a patient for no more than 15 minutes because of uncapped access to appointments. Giving patients our time is the most effective way to healing and preventing ailments. I want my patients to feel like my office is much more than a copay, it’s a step towards their preventative health.
Republicans and the AMA successfully made their socialist argument thus killing Truman’s plan. They stuck with privatized insurance which meant leaving those financially unsupported to the will of charity.
Future advancements came in Eisenhower’s administration with healthcare designated for the dependents of military servicemen in 1956 with the Medical Care Program for Dependents of Members of the Uniformed Services.
The Kennedy and Johnson administrations brought expansions to those of Social Security (65 years and older), to the poor, and to the disabled. Medicaid and Medicare was now expanding. Senator Ted Kennedy called for even further coverage from a federal funding for his entire political career.
It was becoming clear that more governmental officials wanted the U.S. to have universal healthcare capabilities. It was finding the balance between an overbearing mom and one that’s just bearing enough.
Echoing the argument of today, that healthcare should not be an entitlement program and that people with good health should not have to pay for those who cannot afford their own, Ronald Raegan was against federalized healthcare. He did, however, pass an increased coverage package for Medicare/Medicaid but only those who were on it had to pay for its rise in costs. Bush Sr.’s administration repealed it because of the disastrous financial burden on individuals. Clinton’s administration tried for universal healthcare but was stopped in Congress. Bush Jr. added prescriptions to be covered in the Medicare program.
At this point, I know that access to healthcare is a human right. The government should be involved up to a certain extent. However, I still have the ability to provide my patients with year-round coverage without too much dictation from regulations.
The government has kept patients and physicians on their toes for over a century. It’s ultimately unfair to the patient as I see the need for just basic, preventative care no matter their class, race, or yes, even preexisting conditions. No physician wants to turn away a patient.
Enter President Obama and the ACA:
The Affordable Care Act (ACA) or Obamacare was considered a legal form of taxation and the Supreme Court ruled the ACA constitutional. The Obama administration became the first administration to pass a law for access to universal healthcare.
The general idea behind Obamacare is that by either forcing everyone into enrollment or paying a fine to opt out, prices are kept lower for those who wouldn’t be able to obtain insurance without it. By revoking that mandate, many “healthy” paying people would opt out thus putting a burying burden on low- income users and those with pre-existing conditions; sound reminiscent of Raegan’s attempt?
Part of the ACA that may never be able to be repealed is that its insurance covers preexisting conditions, no rises in premiums for sick care, cut out lifetime coverage limits, and can’t deny someone based off their income. These have all been limitations of private insures. Insurers, to offset those costs on their profit, have raised their premiums for those who don’t receive an ACA subsidy.
That is where the problem lies. It has become more clear than ever that the healthcare industry has become more so a business for profit than a business for health. I became a physician to cure not to cash-in.
So why is private insurance so high and so unobtainable for some families?
A lot of the problem starts within the industry. It starts with hospitals, drug manufacturers, and medical device manufacturers. Insurance companies compete for the most successful medical practices without negotiating pricing; they just want their insurance to be accepted. In other words, insurance companies are competing for their network (and therefore profit) and not necessarily for lower prices for their subscribers.
Because of this, when hospital and medical prices increase, those prices are increased in the form of premiums while still dictating what can and cannot be covered. It also affects where and how patients can be treated by their physicians. Smaller practices tend to have their care covered disproportionately to the services provided. This unfortunately means that smaller practices will opt out of certain insurance providers, thus limiting their patients to physician access.
Yes, the ACA had a similar effect because in trying to keep costs low, physicians in some insurance networks were lost. Ultimately, however, networking is at the discretion of insurance providers.
What is the solution?
The solution for patients everywhere is Direct Primary Care (DPC). It’s like having brought your lunch to school but knowing Mom is still there to drop it off if you needed her to.
It’s a model adopted by many European nations as the first form of general healthcare. With DPC, doctors don’t need to worry about insurers scamming them out of payment and patients don’t need to worry about being denied care or over paying for full-coverage insurance.
Full-coverage insurance is just another design made for profit. DPC allows insurance to be reserved for what it was meant for- catastrophes. As long as you are registered for a catastrophic plan that means the ACA standards, there are no penalties for enrolling in a DPC plan.
I see firsthand the manipulation insurer’s play with both my practice and my patients. I decided to opt out of their intervening. DPC means patients do not have to compete with other patients for doctors in their insurer’s network, and that’s what I like.
Instead of being a part of an insurer’s network, patients are a part of my network and that is personalized healthcare.
“Maintenance” care should paid for out of pocket. This limits government and private insurer involvement. Not so coincidentally, there is a reduction in overall emergency sick care when there is routine preventative care. DPC promises a fixed monthly payment of unlimited access to your doctor without the overhead cost of full-coverage plans’ copayments or deductibles.
Ultimately access to universal healthcare is an admirable task. However, those stuck in the middle have a solution to the unpredictable costs of the whole ordeal. It puts your health in your hands but with minimal, added protection from the government.
We are happy to provide Central Florida the mom-like safety net of Direct Primary Care. Call us at 407- 878- 7990 to find out how you can benefit from your own physician network. Our DPC office provides Women’s Health Care, Geriatric Medicine, and of course your Lake Mary Pediatrics.
