By Elizabeth Crocker, RN, MSc
I’m betting the farm that all of us believe that we control our own destiny. But how do we control our healthcare — how we access it, use it and benefit from it?
We can rightfully be angry and frustrated at the demise of the US healthcare system, now declining at a more rapid rate than in the past 20 years, particularly at the expense of women and children. But we cannot rely on a top-down fix, nor can we take a scatter-gun approach to a bottom-up fix.
For too long, there has been an unrealistic reliance on the US Congress to fix healthcare without fixing the real problems they should be targeting: the unrelenting, obscene cost of drugs and medical devices, which are passed to the providers, who then pass them on to consumers and their insurance payers (employer and individual medical insurance, Medicaid and Medicare).
The Obama Administration recognized the importance of shared responsibility among individuals, providers and insurers to create sustainable “healthcare for all,” and in doing so, created a new way forward. The mandate to buy a plan, or pay an additional tax, created the wider shared responsibility model — not a perfect one, and one in need of improvements, but a start. Meanwhile, the Trump Administration is blind to the humane right to healthcare for all. By canceling the individual mandate, it has widened the elitist divide between the “haves” and “have-nots,” relegating the latter to no-person’s land. Furthermore, the administration has lowered corporate and capital gains taxes instead of redirecting public funds to provide universal healthcare — and then they call it “America’s Great Healthcare System!”
While the mandate for everyone to buy health insurance was the least popular of the ACA regulations, consumers are much more aware of the need to have health insurance, and the importance of shared responsibility between themselves, providers and insurers. The insurers, while suffering the loss of some income, have become more flexible in their arrangements. And pre-existing conditions are still covered — for now, anyway.
But healthcare is still too costly and inconsistent, especially state-to-state, because the Health Insurance Portability and Accountability Act (HIPAA) — which protects health insurance coverage for workers and their families when they change or lose jobs — is not a substitute for fully portable healthcare. Further to this, there simply are not enough “healthy” people buying insurance, so the burden of the unwell dominates the insurance cost factor.
For those of us living in the UK who enjoy the benefits of the National Health Service (NHS), with its enviable cultural ethos, we can use our knowledge of the system (whatever its flaws) as a basis for working toward sustainable healthcare reform — meaning universal access to high-quality, affordable care, fairer drug prices, and coverage for those with pre-existing conditions. But we have to make these changes state-by-state, issue-by-issue. If we attempt to tackle all the problems at once, the boondoggle curse of the ACA, we will continue to be frustrated and disappointed.
To quote from CNN Politics July 24, 2018, “To crack Trump’s voter base, Democrats must focus on opportunity, not outrage.” Let’s convert our outrage into useful energy to make a difference!
To improve not only the ACA but healthcare reform in general, we must be laser focused and informed. The absolute must reads to research your issues and find ways to support stateside initiatives are:
The biggest influence we can have from abroad is to work with voters, not only to get out and vote, but also to get involved with state action groups and committees working on the key issues that concern us. Required reading: https://www.nga.org/center/issues/state-health-reform-initiatives/
Know when not to perpetuate ill-advised messages: Modest premium increases hurt Democrats’ midterm messaging.
And let’s get started…