Friday, November 2, 2012

A Proud SOB’s Perspective on Healthcare and the Election

I am a proud SOB—Son of a Bartender—just like John Boehner (R-OH), the Speaker of the House of Representatives.  We both grew up helping out in our Dads’ working class bars—in my case, I was the third generation to tend bar (summer job while in college) in Doherty’s Bar in Woodside, Queens, NY, owned, operated and tended by my late father Jack Doherty, an Irish immigrant.  Where I respectively disagree with Speaker Boehner is on whether the Affordable Care Act (ObamaCare if you prefer) will help or hurt working class people, like the longshoremen, cops, construction workers and firefighters who patronized my Dad’s establishment.  I believe it will help them and should be fully implemented, Speaker Boehner believes it will hurt them and should be repealed.

I am sure we can both cite statistics and studies to back up our views, yet I think it is important to go beyond the numbers and look at how it specifically will affect real people with real healthcare needs in real jobs, such as those who tend bar or wait tables for a living.   Which brings me to a Missouri bartender I met back in 2009,  before ObamaCare became law, who overheard a conversation between me and Dr. David Fleming, the then-governor of our Missouri chapter and now a member of ACP’s Board of Regents.  This is an excerpt from what I wrote then in this blog:

"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, three years later, and just four days before the election, I can say that the politicians in Washington did come through for her:  the Affordable Care Act will expand Medicaid to everyone with incomes up to 133% of the FPL, and provide sliding scale subsidies to buy private insurance for people up to 400% of the FPL through state-run health exchanges.  Less certain is whether the politicians in Jefferson City, MO, will come through for her, because they have to agree to the Medicaid expansion and the exchanges.  But if they do, this Missouri bartender, her self-employed husband, and her disabled adult daughter should have guaranteed, affordable health insurance coverage for the rest of their lives.

I can understand why many voters have concerns about the ACA, mainly because they believe it is too expensive and gives too much power to the government.  But as a proud SOB myself, I hope that we keep in mind  that because of ObamaCare,  this Missouri bartender, and so many others like her, will for the first time in their lives no longer have to worry about not having access to affordable health insurance coverage, unless the voters decide otherwise next Tuesday.

Today’s question:   What do you think is at stake in the election for this Missouri bartender, and so many others like her?


Unknown said...

I am a young physician and informal student of health policy in Portland, OR. I enjoy your blog and usually agree with your policy positions. However, I am deeply disappointed in the ACP and its division of Government Affairs and Public Policy for taking such a weak stance in this election. You know, and anyone with any legitimacy in health policy knows, that this current president's policies are better for healthcare than those of Governor Romney. The ACA is unfortunately not a end solution to our healthcare woes, especially since the public option component was removed (ooh, that hurt). We know that. But it is much better than the system we have and clearly converting Medicare into a defined contribution system would be a disaster.

So you are on the right side of policy. That's great. Now it's time to stick your neck out there and actually endorse a candidate or candidates that support those policies.

Andrew Seaman, MD

BDoherty said...

ACP by law can't endorse candidates. It's is classified by the IRS as tax exempt charitable organization chartered to promote the public good through education and iby law would lose its tax exempt status if it were to endorse candidates running for political office. Plus even if the law allowed us to engage in such activities (but it doesn't) we believe that we have far more credibility advocating for the policies we believe are right than getting drawn into the politics of pushing one candidate over another. We also respect that our own members have a broad range of views and political leanings and we need to respect that diversity and their own ability to make their own choices in an election.

PCP said...

The self certitude of you liberals never ceases to amaze. Dr Seaman when you say "we know that". Who would that "we" be referring to? Do you bother for one second to think that somehwere near half the country does not know that?
I think ignoring that and then saying what you say can be called arrogance.
Respectfully sir, I do not know that. I do know that you liberals got a victory and the ACP endorsed the law, but that is all. What it will do to health care quality and costs as well as to my profession are all open questions at this stage. I have my opinions on that as I am sure you do yours, time will tell.