Friday, October 2, 2009

Will health reform help a Missouri bartender?

Early this morning, the Senate Finance Committee finished its work on amending the bill drafted by Chairman Max Baucus (D-MT). A final vote within the committee is expected next week. Baucus says he has the votes to get it out of committee although it remains unclear if Senator Olympia Snowe (R-ME) will vote in the affirmative, in which case she would be the sole Republican, Senate or House, to vote for the health reform overhaul. Assuming approval by the SFC, Majority Leader Harry Reid (D-NV) will work on melding the SFC bill with the version approved by the Health, Education, Labor and Pensions Committee, with a floor debate and vote in mid-October.

As the Washington Post reports, approval by the SFC and HELP committee and the three committees of jurisdiction in the House of Representatives, will take health reform farther along the road to enactment than any other time in American history. It is looking more and more likely that there is a consensus among Democrats to get a bill sent to President Obama for his signature. Nothing is assured, though, until the final votes are cast.

Although all of the attention is on Washington, I am reminded of a recent conversation with a woman in Missouri that reminds me of what health care reform is all about. I was in Missouri attending the ACP chapter meeting. Over several beers at the hotel bar, Dave Fleming, the ACP Missouri chapter governor, and I were debating whether health care is a right, privilege or societal responsibility. Our bartender overheard our conversation and asked if health care reform would help her and her family.

She said she has some serious health problems that require expensive medications, which are only partly covered by the health insurance plan offered by her employer. Her company plan also covers her 19 year old dependent daughter with a serious mental health condition. Her husband, an independent contractor who can't find coverage on his own, also relies on his wife's plan for coverage. She said that even with the insurance, her premiums and out-of-pocket health care bills are so high that "I don't know how we'll make it". She was planning to take a day off from work to plead with state Medicaid office to cover her daughter, even though she had already been advised over the phone that her daughter wouldn't qualify.

Dr. Fleming and I explained that health care reform might make her daughter eligible for Medicaid, because the pending bills would require the program to cover anyone up to 133% of the poverty level (we didn't ask her how much she and her husband earned). We also told her that she might be able to get subsidized coverage through a health exchange, and that insurers wouldn't be allowed to turn down her daughter or charge higher premiums because of her pre-existing mental health condition. She wistfully responded, "I hope so" but sounded unconvinced that the politicians in Washington would do these things for her.

As the politicians continue to debate the intricacies of such things as excise taxes, budget offsets, health exchanges, subsidies, mandates, and public options, I hope we don't lose sight of this Missouri bartender, and the millions of working American families, who can't afford health care and are looking to Washington for help. None of the bills making their way through Congress are perfect - far from it. But I believe the litmus test of whether the results are worth it is whether our Missouri bartender and her family can get good coverage at a price that they can afford.

Today's question: Do you have confidence that the politicians in Washington are going to produce a bill that provides help to this Missouri family and the millions like her?


Robert J. Sobel, M.D. said...

That would be great and asking us whether we are optimistic is a bit of a leading question. I still find the effort to instate quality initiatives as a new bureaucracy with a far greater inherent risk than benefit. What fee schedule formula will protect physicians from the growth curve of new drug and new technology prices? What fairness doctrine will protect me from the corporate hassles? How will the balance between innovation support and implementation be struck?

Rich Neubauer MD said...

To the question of whether politicians in Washington are going to produce a bill that provides help to the millions of un and underinsured, I can only say I hope so.

Stories like that described in your blog entry and many worse than that can be told in this country. As a citizen and as a physician I find it unforgivable that we allow this kind of nonsense to continue.

The facts that back up the feasibility of reform have been clearly laid out. The special interest groups have done what one would expect of them -- they have whined and outlined every reason why we should change very little if anything.

So far, my impression is that few politicians have shown true courage in the health care debate. As the end game unfolds and the House and Senate try to reconcile substantially different approaches, perhaps that will change.

The good bet seems to be that a health care bill will emerge in the end. A legitimate fear is that what emerges may be so watered down as to be ineffectual. I hope that will not be the case and that what comes of this effort will be substantive and formative.

In regards to your debate with Dr. Fleming about whether health care is a right or a privilege, I continue in the belief that unless we as a country decide everyone should have health coverage for a basic set of medical needs we not only place ourselves in a shaky ethical position but we will also be unable to address "bending the cost curve" and unable to address the structural problems in the system like the crisis in primary care.

Joseph said...

Great test case. If health reform is to help anyone, it should help this bartender not only in terms of health coverage, but also in terms of a sense of security for her family. Next problem will be whether she can find a primary care doctor.

DrJHO7 said...

Health care is neither a right, nor a privilege.
Like air and water, it is a necessity.
I, too, am concerned that the cracks in the health reform bill that is eventually passed will be like chasms, allowing almost as many Americans to fall through as our current system does.