In our states — Washington, Kentucky and Connecticut — the Affordable Care Act, or “Obamacare,” is working. Tens of thousands of our residents have enrolled in affordable health-care coverage. Many of them could not get insurance before the law was enacted.
People keep asking us why our states have been successful. Here’s a hint: It’s not about our Web sites.
Sure, having functioning Web sites for our health-care exchanges makes the job of meeting the enormous demand for affordable coverage much easier, but each of our state Web sites has had its share of technical glitches. As we have demonstrated on a near-daily basis, Web sites can continually be improved to meet consumers’ needs.
The Affordable Care Act has been successful in our states because our political and community leaders grasped the importance of expanding health-care coverage and have avoided the temptation to use health-care reform as a political football.
The cholesterol guidelines released last week are already poised to drastically increase the number of people prescribed statin drugs, and this calculator that the American College of Cardiology just unveiled will help people miscalculate their risk (substantially upwards, of course) even more.
“[It] overpredicted risk by 75-150%, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment….. Miscalibration to this extent should be reconciled and addressed before these new prediction models are widely implemented. If real, such systematic overestimation of risk will lead to considerable overprescription.”
“Something is terribly wrong,” Dr. Nissen said. Using the calculator’s results, he said, “your average healthy Joe gets treated, virtually every African-American man over 65 gets treated.”…
In response to my op-ed in the Kansas City Star this week, I received a wide range of comments. Most were quite supportive. Others were, shall we say, less than enthusiastic about various aspects of the health reform law.
My reply to those commenters:
Regarding the questions you shared with me about the Patient Protection and Affordable Care Act …
The United States is the one nation in the developed world that has not made a decision as a nation to consider health care a fundamental right. The health reform law (Patient Protection and Affordable Care Act of 2010) is the first major step in that direction since the passage of Medicare and Medicaid in the 1960s. It has many moving parts because it builds on the existing flawed system rather than switching to a single payer system, as was done in varying ways in other nations. Some of those other countries maintained private insurance companies but only as nonprofit entities; others went all in with government as the sole payer and/or administrator. The United States is the only developed nation that has private insurers that have to answer to shareholders. I would argue that this is a bug, not a feature.
In my view, all systems have their own unique strengths and weaknesses. The pre-PPACA U.S. system has the unique track record of having the highest (by far) overall per capita health care expenses in the world at the same time that it has many of the worst health outcomes in the developed world. So we begin with a system that is highly problematic, and to cap it off also leaves tens of millions (50M?) uninsured, something does not exist in any of these other nations. Before diving into any particular strengths and weaknesses of PPACA, I think it’s critical to acknowledge that the system on which it seeks to improve is drastically flawed. On at least that one point, I would imagine that both proponents and opponents may agree.
The Kansas City Star has just published my op-edbased on my experiences this year on the Missouri Citizens and Legislators Working Group on Medicaid.
At least a dozen physicians from safety net clinics shared stories of their uninsured, “working poor” patients (most of whom would be covered if Missouri accepts Medicaid expansion) who can’t afford the medicines or other treatments prescribed for their diabetes, heart disease, hypertension or chronic pain. As a result, they spiral downward, suffering greatly as their previously manageable ailments become unmanageable (such as treatable diabetes descending into kidney failure) , at which point their now-severe disabilities allow them to finally qualify for Medicaid, but too late to regain their health.
To put Obamacare victims’ strife in perspective, let’s take a trip down memory lane. You know, the golden years of American health care in … oh, let’s say 2007, back when you could be denied coverage for something as benign as acne or as mundane as pregnancy.
Back then, anecdotes about people who were denied coverage abounded. They included this 12-year-old boy who died in 2007 from an abscessed tooth after his family’s Medicaid lapsed. And this 17-year-old boy whose insurance was revoked after he tested positive for HIV. This woman who was denied coverage for breast cancer because she wasn’t diagnosed at the correct clinic. And this woman whose double mastectomy was denied after her insurance company learned she had visited a dermatologist for acne treatment the year before. Ah, yes, those were the days!
For those who put more stock in headlines, here are a few that help convey the state of the American health care system back in its heyday.
It’s not all anecdotes and headlines. She goes from there to a series of links to policy papers and the like.
We are currently in the early stages of what will likely be a decade-long transition to a new model. There will be bumps along the way. There are some now. But it’s important to remember why there was such a hue and cry for reform in the first place.
On the basis of a review of scientific evidence and findings from expert panels, the agency made a preliminary determination that the oils “are not generally recognized as safe for use in food” and should be eliminated, FDA Commissioner Margaret Hamburg, MD, said on a conference call with reporters.
The decision “is very welcome and strongly supported by massive scientific evidence that trans fat has many adverse effects on health,” Walter Willett, MD, DrPH, of the Harvard School of Public Health, said in an email to MedPage Today. “Trans fat has no place on the table, and this step will help make the diets of Americans safer.”
Harvard School of Public Health’s Walter Willett, PhD, puts the change into context:
Willett added, “Further removal of trans fats will also likely nudge down rates of diabetes, obesity, and other conditions as well.”
“Importantly, by getting trans fat off the table entirely, we will be able to focus attention on other aspects of diet that also need to be improved,” he said. “This will likely have a ripple effect worldwide because other countries are considering similar actions.”