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From the Heart

By Dr. Chris Lillis
. 10 Comment(s)

If you have read some of my previous blog posts, you might think I add WAY too many links to my source material.  I am not going to include any links in this piece.

The truth is, I have invested almost 5 years of blood, sweat and tears into ensuring that the Patient Protection and Affordable Care Act was written, passed by both houses of Congress, signed by the President of the United States and survived a Supreme Court Challenge.  Now I am spending my time doing my best to see that the law is implemented.  As much as anyone, I am terribly frustrated with the deficiencies of the website healthcare.gov.  I am more frustrated that a few million Americans may see their health insurance premiums rise as their old policies are cancelled by insurers while making just too much income to qualify for offsetting tax subsidies.  These folks, especially if they are healthy, may not feel that there is any benefit to them to purchase a more comprehensive health insurance policy that they rarely use. 

But here’s the deal: we are all going to be better off.  By expanding the individual health insurance marketplace, we will see health insurance premiums stabilize.  This has not been the case for the past 30 years.  We have seen double digit premium rate increases, year after year, through many presidential administrations, without any legislation passed to protect consumers.  The Affordable Care Act finally protects consumers.  The law mandates that insurance companies spend at least 80% of all premium dollars collected on your health care, a needed provision when all of the major insurers’ CEOs get paid tens of millions of dollars every year.  The law forbids insurers from continuing the horrible practice of rescission, where policy holders are suddenly dropped once an illness is discovered.  The law ensures that your policy is renewable even if you get sick.  The law provides consumers access to an affordable policy, one that does not turn them away for having a pre-existing condition as trivial as heartburn or allergies.  The law prevents an insurer from cutting off support for medical bills since annual and lifetime benefit caps are no longer. 

The law has baked into it pilot projects attempting to revolutionize health care delivery systems.  Currently, we have a fragmented system – hospitals, doctors’ offices, pharmacies, and other providers administered care without much coordination.  The right hand of the health care system often was not aware of what its left hand was doing.  But coordinated care is now the hottest topic in health care thanks to the dialog begun by the Affordable Care Act.  The law has allocated funds for these pilot projects, although many coordinated care initiatives are being led by private hospitals, insurers and communities because of its transformative potential.  This would not have been so without the national debate begun with the Affordable Care Act.

I must admit, the single greatest driving source inspiring me to advocate for the Affordable Care Act are the innumerable uninsured patients I have cared for in Emergency Rooms, Hospitals, Free Clinics, and my office – beginning in medical school over 17 years ago.  I do not ever want to say to a patient, who is desperately asking me “how am I going to afford this,” that I am not sure how we will obtain a test, procedure or life saving medicine.  I want to be able to say, “You’re covered.” 

The Affordable Care Act has standardized – across Medicare, Medicaid, Tricare and private insurers – that preventive care is to be provided without out of pocket costs (co pay or deductible).  My practice experience has made it crystal clear that out of pocket costs shape the decisions of patients.  If it is unaffordable, they will delay needed care.  Without out of pocket costs for preventive care, it’s not quite as much of a challenge to help patients participate in recommended disease screenings.  

Underappreciated by all, The Affordable Care Act is going to encourage providers to focus much more on the costliest element of our health care system: those individuals who require complicated, ongoing, disease management.  When chronic care is executed poorly, preventable complications occur in patients with skyrocketing downstream costs.  Our sickest patients with the greatest need represent 84% of total health care expenditures – 99% of all Medicare spending.  The Affordable Care Act is going to encourage providers to screen for chronic diseases and intervene early while those conditions are still easily manageable using effective and efficient coordinated care. This will allow us to reduce health care spending for all of us – everyone who pays taxes and everyone who pays health insurance premiums.

The mantra of the Affordable Care Act among “insiders” mirrors the mission of the Institute of Healthcare Improvement – better individual care, better population health, at a lower cost for all.  This is the so-called “triple aim” drilled into us by Dr. Don Berwick.  I strive for this, as I know the 16,000 members of Doctors for America do every day.

You cannot communicate all of this in a sound bite.  Even harder is communicating all of the provisions in the law in a discrete period of time (think cable news).  I can speak ad nauseum about our $2.3 Trillion dollar health care system – we spend more on health care than the size of the entire national economy of all but 6 other countries. It is remarkable, and discouraging, to know how complex our health care system is and just how complex this law is, meant to attempt to improve just about every aspect of it. 

The Affordable Care Act will improve our health care system so long as it is allowed to work and provided some help in properly achieving implementation.  I am privileged in my career to have been witness to the most affluent and high tech care in the Duke Medical Center Intensive Care Units and the most impoverished care on the trauma surgery service at the District of Columbia’s General Hospital.  After taking care of thousands of patients in my lifetime, and immersing myself in health policy in the last 5 years, I want to see the Affordable Care Act succeed. 

Success will depend on advocates like Doctors for America sticking with this effort – learning about loopholes and problems and applying the proper fixes to the law.  This has a long tradition in our great nation.  After Medicare’s passage in 1965, there have been both major and minor changes to the program every year to make it better.  The Affordable Care Act has the same potential to improve year-after-year. 

The Affordable Care Act is here to stay, but without better public education and understanding, the effectiveness of the law is in jeopardy.  It would be foolish to abandon this critical law simply because a website is temporarily not functioning.  A website can be fixed. 

We need to meet the Americans who are losing their previous insurance policy and make too much to qualify for a subsidy.  These folks are angry, and understandably so.  I hope with good information, they will see that they will benefit in the long run.  I hope they never have to learn of the protections of their new policies due to a devastating illness, but I am glad if they get sick they will avoid bankruptcy. 

Every victory for this law brings new challenges, and that’s OK by me.  The law was never going to be perfect and fix everything.  It’s a start.  I have a feeling that I and my colleagues at Doctors for America will need to continue to work to improve our healthcare system for quite some time to come.  We plan to see this through.                          

Share Your Comments

 

  1. Gae Pinschmidt

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    Dr. Lillis:
    Profound thanks for your good heart as well as your good head. I am sending your comments to everyone in U.U. Life Preservers, as well as contrarians who need to understand these perspectives.

    We are all in your debt.
  2. Anshu Guleria

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    Well said, as usual. I personally have registered on the healthcare.gov site and am shopping plans for my family. I have encouraged my employees to do the same.
  3. Kathy Anderson

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    Articulate and compassionate. Thank you for your time and expertise and using it to inform and balance out the attacks. The law is not perfect and falls short of what our Nation needs but is a step toward keeping people from being left out of healthcare we (collectively) need. Each of us never know when we may face a health crisis and I thank you for outlining all of the ways that our system has turned its back on so many of us under the status quo. Thank you for keeping up your efforts.
  4. Thomas N Maloneu

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    Absolutely the best explanation I've come across. Thank you, Dr Lillis! I have reproduced your commentary and placed it in the Doctor's Lounge of my hospital. This should be REQUIRED reading for ALL. My "Aha" moment on the ACA !
  5. Morris Brown MD

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    Comprehensive,informational,motivational,This will be sent to the membership of my group Providence medical group,Dayton,Oh &the membership of National Medical Asso.
  6. Julia Frank

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    I'm with you on this! And I hope that the new mental health care parity rules will also help in my domain
  7. Aimee

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    I checked the website created by a few computer nerds in 3 days that accomplished what Healthcare.gov could not in a few years. If our coverage was cancelled, like many of my friends has been, we would be in real trouble. We are one of those families that would not qualify for subsidies. I priced out the premiums for a comparable plan for our family. That monthly cost is quite a bit more than our monthly mortgage payment. We are healthy. So you are saying that it is okay for us to have to figure out what bills not to pay, so we can pay $1,200 per month for a service we may not even need? Crazy! This plan has NOTHING to do with healthcare. It has everything to do with more power and control over our lives and it was sold to the public on many lies and closed due to backdoor deals. I could not be more disgusted than I am now that Chicago-style politics has made its way to DC, which was already bad enough before. And now we have navigators caught on film telling applicants to be untruthful on the forms so they don't have to pay higher premiums. We also see that this is just another redistribution scheme to funnel grant money supplied largely by the middle to upper class to PACs "committed to turning Texas blue". Congrats on your "transformation" of America that is turning us into a nation of beggars for handouts of other people's money.
  8. Aimee

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    Also, I checked out out your likes on FB. Your credibility rating is zero after seeing that you are nothing but a cheerleader of left-wing politicians and organizations. Jan Schakowsky & Al Franken? You can't get much more left wing than that. Why should I take anything you write to heart when you obviously do not care what about half of the population thinks? You also like pages that are disrespectful to my congressman and ex-Vice President. Why should anyone listen to what you have to say? I hope you never claim that you are not biased in your views when you are an OFA supporter.
  9. Bret S

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    Drink more Koolaid. Your vision of healthcare is both myopic and simplistic! You are a political sell-out to the once great medical system in this country! Enjoy the fracture which has been created in our ability to treat patients! I hope your marginalized practice will gain approval with all of the allied health 'professionals', to whom you will now answer. You know-it-alls will be oh so collegial with the disciplines that have half of your training and all of your former power under this great new act.... Enjoy holding court, sycophant!
  10. Pulmonary md

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    I agree that the intentions set forth are on paper quit nice. However, most systems fail for a number of reasons. I am concernd that the law of unintended outcomes will prevail sir. Likely nothing will really change. The better off will end up providing for the underservd. Not ethically a bad thing but financially it will break the already broken economy. Just because doctors for America want something to happen does not mean it will. There is a reason why a large proportion of practicing physicians do not support this. Medical students are not a good judge of what is going on. Also if every physician works for free or was paid less do you really think we would save money....no. So why do we think that becaus everybody gets health care on paper is going to get healthcare access.

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