#Danee gets poltical

[itsrainingjellybeans]

Repeal the ACA?

This is in response to a FB post that someone commented a story about a Trump supporter who is now worried she will lose the ACA. The man commented that her story was BS and that hospitals HAVE to take care of everyone-”if they don’t kill you with malpractice”- that you can pay $10/month or file bankruptcy to pay for health care but that Obamacare is broken and imploding on itself with companies pulling out and premiums going sky high until it is basically catastrophic health care.  This is my response.

I speak as a nurse practitioner AND a patient with a complex genetic disorder AND as the mom of 2 kids with the same disorder that has presented in different ways so I've seen A LOT of doctors in a wide variety of specialities as well as worked in clinics and hospitals. I am personally and professionally offended by your statement that they are trying to kill you with malpractice. There are hundreds of thousands of doctors and nurses giving everything they have to keep people alive every single second in America. Hospitals don't try to kill you-Americans are doing a great job of that all by themselves- eating processed foods which are basically almost impossible to avoid in this country in 2017, not exercising adequately, not sleeping, texting while driving, stress and mental illness going untreated and our lack of community, compassion and humanity is eating away at our health. But let's say you only eat things you grow and you butcher and you are zen. Your body IS STILL going to start declining at about age 40. Yes, there are a lot of problems with our medical care system and a lot of idiots practicing medicine but MOST want to do well. The human body is very complicated and patients don't exactly do what they are told to do. Also think about it- if nurses and nurses are 99% accurate which is way above the average performance rate of most workers, that means they will make 1000's of mistakes a year and some of them will be deadly.

Now on the ACA argument: 1. Yes, hospitals are required by law to see EVERYONE for EMERGENCIES but only for emergencies. They don't have to see you for chronic psoriasis or a long term cough and they have no ability to care for you after the initial stabilization. There is no mandate to admit you for anything once you are stabile. SO while they must stabilize your diabetes if they are able to stabilize you in the ER, they can discharge you home and they have no mandate to help you with follow up. This is a huge hole in the often-repeated theory that "hospitals must care for everyone". 

2. In a lot of areas patients can't be seen by doctors if they don't have insurance. In other words, they won't even make an appointment for you if you are uninsured. There is no bill to pay off over time because you can't be seen. I had a patient with a grapefruit-sized tumor in her uterus. I saw her at the health department but nobody would see her for imagine to diagnose it further. NOBODY-because she was uninsured...except the ER -which is where I told her to go, but I doubt she went because how would she pay for treatment? The tumor was growing quickly so it wasn't going to turn out to be "nothing". 

3. Hospitals won't let you pay $10/week. They want a much higher percentage of the bill WITH a down payment and they want to negotiate the bill right NOW and you only get a small grace period before they are sending you to collections. 

4. The #1 cause of bankruptcy in America is medical expenses and THAT isn't a statistic to brag about. It is abhorrent that people can't access basic health care and that you think bankruptcy is a viable option to pay for health care. That it is more viable than fixing the problems with the ACA. America is the only developed country without guaranteed health care for ALL. 

5. In 2016 7 out of 10 returning Marketplace customers could get a plan for less than $75/month and 8 out of 10 for less than $100/month. In 2017 even with rate increases THOSE STATISTICS STILL STAND!!!!! 

6. The livable wage issue and part time vs. full time work issue is another topic but suffice to say that as long as corporations are controlling the GOP you will not see a living wage for workers outside corporate America. CEOs only care about their shareholders and the next corporate earnings call. That is about as far thinking as they get these days. 

7. 30M Americans have health care coverage because of the ACA. To take that away form them with nothing equal to replace it is inhumane and NOT how we do things in America. The fact is we could pay for single payer healthcare if we don't build a pointless was and cut taxes on the wealthy again. 

8. The ACA IS NOT Perfect. There is no doubt that a group of people in the middle class have extremely high premiums and that has to be fixed. But keep in mind that issues wouldn't be a there if the GOP hadn't kept the mandate out of the law. A lot of the problems that the GOP sees with the ACA are problems they brought to the table. They have had 7 + years to come up with a plan and they can't. 

9. One thing that has them really pissed off is that when ACA was first implemented they did a great job of getting RushRadio and FoxTV to sing a song and dance that the ACA was horrible before Americans had a chance to use the program.For a few years it worked. Obamacare had a bad reputation but over time, as people finally got the health care they long needed, the perception changed. People realizes that health care is a wonderful thing to have and not the evil, sinister thing the GOP sold them in 2009 and 2010. It was mind-blowing to me to watch Americas argue that health care coverage for all was a horrible thing and something they didn't want. Thankfully it was all GOP Propaganda marketing and when American's got health care coverage, that view changed dramatically. The GOP wasn't watching. Nope, they were still over in their corner-using their cadillac plans to care for themselves and their family- thinking Americans still hated Obamacare and a repeal was a slam dunk. I think Trump had it on his Day 1 agenda or close. Unfortunately for them the push back at the grassroots level has been spectacular. My Deep-As-They-Come Republican Representative has changed his song for a HARD REPEAL to Repeal with Replacement. If this corporate-owned politician who has voted 27 times to repeal the ACA can change his tune, they all can. Our new goal is to get him to FIX not REPEAL. 

10. One thing that has been expensive for insurance companies has been the fact that many people who signed up for ACA have long-standing, untreated health problems which means a lot of catching up with therapies, doctors, medications, etc. It takes a lot of resources to get them back to health and that is costing the insurance companies a lot of money. Another problem is the insurance companies didn't use a model that allowed them to be profitable under these conditions. Medicaid and Medicare have long been examples of efficient and cost effective health coverage and a few insurance companies are doing well under the ACA, but those who failed did so at their own fault by not following the lead of Medicaid and Medicare. Seven years into the program, some are figuring out how to make a profit in this environment. 

Why would it make sense to throw out ACA and start over? This reminds me of the old saying "don't throw the baby with the bathwater". We need to fix the problems not start over or as Ryan and the GOP want, give Americans Health Savings Accounts which is so stupid I can't even comment on that here. Why would anyone expect legislation this large, one that profoundly changes the way our society functions would be perfect in its first form? Why would anyone expect that health care coverage on this magnitude wouldn't need twerking and even major fixes during its initial years? As for companies leaving the exchange- Aetna left the program simply as punishment when the Obama administration refused to approve their merger with Cigna. That was all politics. Some companies are trying to put pressure on the system to allow them to sell across state lines because that allows them to go to states with fewer regulations so they can offer less coverage -another example of a company relocating simply to improve their bottom line and not that of their customers. 

There are many stories of people who wouldn't have any coverage if not for ACA .Clearly you fall into the group that is paying ever increasing premiums and deductibles and it essentially becomes catastrophic coverage. That needs to be corrected. But 30M people rely on the ACA and there are millions of stories of lives being saved because of that coverage. 

Let's talk about how hospitals feel. Hospitals can't go back to the old system where 30M people didnt have coverage and therefore the hospital is left with 30M unpaid bills. Imagine how you would keep your business open if people who owed you thousands of dollars were paying $10 a month. It isn't a sustainable business model, even for public and university hospitals. They rely on Medicaid and Medicare to help pay for services and they do not want to see ACA repelled. Frankly, neither do the insurance agencies because to repeal without a viable robust replacement is going to create a chaos that they don't want to see either.

It only makes sense to go to single-payer healthcare. We are the only developed country who doesn’t take care of its citizens in this way. Medicare and Medicaid have proven very efficient methods of health care giving us a model to build upon. Health care has become yet another system that is easily accessed by the upper middle class and up and something the lower middle class and those in poverty struggle to get. Even children are often left out as Dentists rarely take Medicaid. I have cared for many kids who come in for their yearly physicals with holes cavities in their teeth so big I can see them from across the room and I cannot imagine how painful that was before the cavity ate the root away. Children...suffering because American’s can’t agree on Single-Payer Healthcare. We need to step up.