Why I’m Enlisting in the War Over Healthcare Exchanges

 I have seen perverse incentives in healthcare have perverse effects on the lives of patients struggling with difficult illnesses.  I support the Affordable Care Act (Obamacare) because it’s a real effort to make things better. Patients and their families struck by severe diseases (I treat multiple myeloma and leukemia) are plunged into a “healthcare system” that is nothing of the kind but is rather a “sickness intervention industry” that often takes advantage of people at their most vulnerable. Sadly, the healthcare system we have now is optimized well for only one thing: making profits from illness. Pharmaceutical companies, hospitals, and health insurance companies are extraordinarily profitable.

What people don’t know is that despite all the money being spent, getting sick in the US is a crapshoot. You may get great care, especially if you have stable employer coverage. Loss of insurance is usually a disaster because simple common sense services may become impossible to afford. Most doctors and nurses are hard-working, well-intentioned people. But sloppy medicine, unnecessary procedures and prolonged hospitalizations happen routinely because healthcare providers get paid by what service they provide, and not by how much benefit you receive. The current fee-for-service system is the problem–it undermines good intentions and works against the patient.

The battle is right now heating up for the fate of the healthcare exchanges (essentially very complex web sites to help people buy insurance). The health insurance exchanges are the centerpiece of Obamacare and are scheduled to open for business on October 1st 2013. If the Obamacare exchanges are successful, they will extend coverage to more people while helping to restrain the growth in healthcare expenditures. I am eager to see whether this experiment will work because we need to un-perverse our incentives. Incentivizing healthcare that actually improves health is worth a try. I suspect better incentives will lead to more rational spending and better care for everyone.

“Bending the cost curve,” the holy grail of healthcare reform has already begun, and it upsets me to see people denying this reality and making bold proclamations based on the ideological belief that unfettered capitalism is the only kind that works.  Republicans see Obamacare on the verge of its final implementation and are fighting by any means necessary to screw things up. Opponents of Obamacare have largely political motives and use misinformation to make their points. This turns my stomach. I don’t always agree with the Editors of the New York Times, agree about Republican Obamacare opponents that, “Their tactics are despicable.“ GOP chicanery is clear if you know that the health exchanges were originally a conservative idea designed as a free enterprise solution to counter the movement towards a single payer system on the left. Most of the politicians on the right who oppose Obamacare supported the idea before Obama signed it into law (remember Mitt Romney and Romneycare in Massachusetts? 

Again, the NYT Editors: “The Republicans’ determination to destroy health care reform has become an obsession that, if successful, will deprive millions of Americans of health insurance they need and want.” I feel sympathy for this well-intentioned notion but have come to view the “we need to do this for the X people” rationale as paternalistic. The other thing that drives me to support the healthcare exchanges, besides the odiousness of it’s opponents tactics, is scientific curiosity. The exchanges are a good faith effort to find a new way to provide healthcare that aligns motives with patient interest, and I admire people working to see if this will work. Attempts to derail this new method before we know whether it will work is are evil. I want to know if this system will work. Almost anything would be better than the old way, and Obamacare opponents are simply lying when they say they have better ideas.

What the New York Times neglects to mention is that Obamacare has been also attacked by liberals and leftists for failing to consider single payer system, or to at least include a public option. These are rational and heart-felt complaints I feel from the “Left”, but “socialized medicine” is not supported by the majority of Americans and faces mountainous hostility from the industries that currently provide healthcare in the US. The success of Obamacare may depend not on politicians or pundits, (surprise surprise) but on regular people. The law is already making positive impacts and continued success depends on proper functioning of the exchanges. I plan to help. Broad enrollment into the exchanges will improve the likelihood the law will succeed. What I plan to do is work with groups that are encouraging people to enroll in the exchanges and save on taxes, starting in October. Lord knows I have my hands full with the work, family and lab, I already have, but I’m going to volunteer and get involved as much as I can.

Suggestion for what you can do:

Choose: a health insurance price point: Platinum, Gold, Silver or Bronze.

Visit: the Obamacare portal 

Amuse: Oregon’s state run exchange advert.  

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