CHARLESTON, W.Va. -- The tea party afflicted Republicans are by and large refusing to implement Affordable Care Act, as the Gazette's editorial of Oct. 22 points out. They would rather stay with the same broken system that leaves millions without coverage and continues to rob Peter to pay Paul.
I have observed both sides of the dysfunction in health care for 30-odd years. It is run like a free-enterprise business when none of the operative factors lend themselves to that model. It is a business where the customer is forced, unwillingly, to buy its services and most of the time someone else is paying for it. The customer (patient) has no control over what he or she must buy and cannot take the business elsewhere if not happy. In most cases the patients cannot even judge if they are receiving value for the money. What kind of free enterprise is that?
When I retired in 2005 my wife was still not eligible for Medicare. No insurance was willing to insure a single individual. Blue Cross offered coverage for $3,000 a month to this healthy woman with no adverse history. Finally, I had to settle on the state pool for "uninsurable" individuals for a premium of $1,200 a month. This is a symptom of a broken system. This is what leads to a $30 aspirin.
Many question the "burden" on young and healthy individuals who must buy insurance under ACA. They don't lament the 'burden' on healthy individuals who carry medical insurance. A small premium charged for insuring the uninsured will lessen the burden for all. By what logic can we say that 'young and healthy' individuals should not be forced to buy insurance? No one minds imposing auto insurance on all drivers, no matter how good or careful. Who covers when the "'young and healthy" individual ends up in the Emergency department after an accident?
The plight of the working poor is most precarious. For them the choice is between a visit to the doctor and bread on the table. They don't seek care till their illness is advanced. In the long run it is costlier to take care of these individuals. A regular visit to a doctor and preventive care is more cost-effective in the long run. Contrary to widespread negative stereotyping, many of these individuals would rather not receive care as charity. Many conservative friends, good people that they are, would rather dole out charity than empower the disadvantaged.
The new program has its bugs. Given a fair chance and time it promises a modicum of fairness in health care. The controversy is nothing new. When the very first health care initiative, Blue Cross, was launched in the 50's, there was staunch opposition by AMA. It was the same with Medicare, though in a more civilized fashion compared to now. All these new initiatives proved lucrative for physicians in the long run.
This law appears so complicated because President Obama had to maneuver a role for insurance industry in the mix to keep free-enterprisers happy.
As for me, I believe health care is a service that should be provided by the government to all as it provides security and national defense for all. In countries with a national health service most patients are quite satisfied. They use a triage system that provides care based on need.
Although many scary stories are circulated in the U.S. about such systems, the statistics bear out the adequacy of the Canadian or European models. The satisfaction level of the population for such systems is also higher than in the U.S. They don't sign a dozen forms before getting care and don't receive half a dozen bills from various providers.
Khan is a Charleston heart surgeon.