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Hippocratic Oath: Is law for the good of patients?

October 2, 2011 12:15 am

IMAGINE YOU are a young woman, like Jane. Jane has a minor medical condition that has prevented her from being able to purchase health insurance (a so-called pre-existing condition). Jane works, quite hard in fact, at several jobs that are entrepreneurial--but her work does not provide health insurance.

In the past, she had been told by several physicians that her minor medical condition would never allow her to become pregnant, but unexpectedly, and happily, she becomes pregnant. Suddenly, routine prenatal visits are costing $400, and she wonders how she will pay for the hospital costs of delivering her baby, which can cost tens of thousands of dollars.

There are millions of stories like Jane's in our great country, but I know Jane. I have personally met hundreds like her--struggling to make sense of our fractured health insurance and health care marketplace.

Before 2010, this was reality in our country. But on March 23, 2010, after much public debate in 2009, the president was presented by Congress with a bill to sign into law: the Patient Protection and Affordable Care Act. You have probably heard it called "Obamacare," but if you are like the thousands of people I have met locally, you probably don't know what is included in the law.

The Affordable Care Act helps Jane. The law created a pre-existing condition insurance, or "high-risk pool," that is open right now for people to purchase policies if they have been denied elsewhere due to a prior medical condition. You may not be aware that prices for these plans have recently dropped. Find out more about them at healthcare.gov.

The act goes still further in 2014 when health insurance companies may no longer discriminate against Americans with pre-existing conditions. People like Jane will be able to shop for better-value health insurance through exchanges set up that year. Through regulations in the act, health insurance companies will be required to offer policies with standard benefits, without fine print to confuse us, and without the ability to drop customers for arbitrary reasons (a practice known as rescission).

Health insurance companies will then be left to compete on price for our business, bringing down the rates for everyone. Those who lost coverage from their employers in our devastating recession will have new affordable options as a result of this law.

GOOD BENEFITS TODAY

Some provisions of the act unfortunately do not begin until 2014, but there are many that are already helping millions of Americans. Young adults under the age of 26 may now stay on their parents' health insurance plan and, as a result, 1 million young Americans gained health insurance between 2009 and 2010. And more than 2 million small businesses are eligible for tax credits right now to help offset the costs of providing health insurance to their employees, fostering economic growth by lightening the burden for our entrepreneurs to help attract the best workers.

The act also already helps Americans who receive Medicare. For the first time, Medicare beneficiaries may obtain recommended preventive care without out-of-pocket costs. There are provisions to lower their prescription drug costs if they fall in the so-called doughnut hole of their Medicare Part D drug benefit. Over the next several years, the act shrinks and eliminates the doughnut hole so that the elderly will not have to choose between paying for prescription drugs or for food. Despite prevalent misinformation, no benefits were cut to Medicare beneficiaries in the act.

I have heard some doctors express fear and doubt about the PPACA, but this year my practice began receiving bonus payments from Medicare simply for practicing primary care. In addition to the primary care bonuses, all U.S. physicians have been offered bonuses for adopting electronic medical records, electronic prescribing, and quality reporting. The act does not fix all problems related to the cost of health care, but it has begun to realign financial incentives for physicians to foster better quality of care and higher value primary care, which ultimately will bring down health care costs and improve clinical outcomes for the entire nation.

The health care system in the United States is the most technologically advanced in the world, and we pay dearly for it. Health care spending in 2008 was $2.3 trillion, or about 16 percent of our entire economy. Yet despite this spending--higher than any other country in the world--we are confronted with tens of millions of Americans--like Jane--who are without health insurance. Citizens without access to health care cannot benefit from our stellar care. In 2010, 45,000 Americans died because of a lack of insurance.

TACKLING THE CRISIS

What is most frustrating to me as a practicing physician is that there is no medication I can prescribe nor procedure I can perform to alleviate this condition. However, the act is beginning to tackle this crisis directly. Estimates project that 32 million Americans will gain access to health care once the law is fully implemented, including Americans who have lost their jobs through no fault of their own during this financial crisis, entrepreneurs who are starting new businesses, new college graduates who cannot find jobs, and those with pre-existing conditions left to fend for themselves.

In presentations to local community groups, I often bring up the example of John, a diabetic patient. If I see John for a preventive physical, and catch the earliest stages of diabetes, I can help to prevent the complications of diabetes with a prescription that costs $4 a month. However, if John lacks health insurance and doesn't see me, he may end up in the emergency room five to 10 years later, never having known he was diabetic.

At that point diabetes has ravaged John's body. Perhaps he then needs laser eye surgery due to diabetic retinopathy and the resources to cope with being newly blind. He may need dialysis for failing kidneys, or perhaps a foot or leg amputated as a consequence of uncontrolled diabetes. Anyone can do the math: Four dollars a month for a basic prescription plus the cost of regular office visits versus hundreds of thousands of dollars for hospital stays and drastic procedures that could have been prevented. It makes economic sense to make sure that Americans can see a doctor when it is necessary.

NOT PERFECT

But to look at this patient with only an economic analysis of his situation is callous. This is a moral issue as well. As a physician who took an oath to alleviate suffering, I see an injustice that needs to be corrected, and the Affordable Care Act makes great strides toward doing just that.

The law is not perfect, but it is an important first step. Laws have goals and unintended consequences, and our complex health care system will require continued innovation to provide the best care in the world to all Americans.

Medicare, the last groundbreaking legislation to change health care in America, was signed into law in 1965. Changes to the Medicare program have been made every year since its inception 46 years ago. Some changes are small, some large, but always in the attempt to improve the program for its beneficiaries.

I am eager to help shape continued improvements to our health care system that the act has begun, and to take these innovations further to best serve the American people. By becoming informed about the facts of the law, you may be a part of improving our health care system, too.

(A comprehensive source of information about the Affordable Care Act, comes from the unbiased Kaiser Family Foundation at healthreform .kff.org.)