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I Will Direct My Apologies Elsewhere

By Dr R Scott Poppen

‘Tis the season for apologies.  Fellow Progress Note blogger and ACA advocate Dr. Chris Lillis fretted about any overstatements he had made in his advocacy for the new law.   Then it was President Obama’s turn to take a public beating and say he was sorry he promised people that they could keep their current insurance if they liked it.  But as for me, no lost sleep here.

 President Obama probably should have been more careful.  But it was probably inevitable, in light of our nation’s absurd reliance on 15-second sound bites as a substitute for thoughtful discourse on critical public policy issues, that he would put his foot securely in his mouth.

We Doctors for America advocates had a slightly less daunting task.  We had a whole 30 minutes, and a couple dozen power point slides, to summarize one of the most complicated pieces of federal legislation ever promulgated.  Or we had a few minutes to talk with someone on the street, answer tough questions, and summarize the important parts of the law.  In my advocacy efforts I have always tried to honestly portray the law, warts and all, and not overstate what it would accomplish.  I have observed my fellow advocates doing the same.   But given the complexity of the subject and time limitations, generalizations, which could later be picked apart to show some exceptions, were unavoidable. 

 Anyone who truly understands the law, and understands insurance, should have known that the ACA would produce, at least short-term, financial winners and loser.  Should we have stated that up front?  Maybe.   But we were unlikely to do so in light of the ferocity and untruthfulness of the attacks made by the ACA’s most vicious opponents.   Maybe it is time for a soul searching discussion about the ethical responsibilities associated with advocacy related education.

 So everyone is now apologizing to folks in the individual health insurance market who can’t renew their current cherished policies, some of which are so crummy that it is a stretch to call them insurance, and will be paying much more in the Marketplaces because they make too much money to qualify for a subsidy.

 So, since repentance is the order of the day, here is mine.

 To the woman who testified at my state’s Medicaid expansion hearings last July  I’m sorry that you developed advanced breast cancer several years ago, lost your job during your radiation and chemotherapy treatments, couldn’t afford your COBRA payments to keep up your insurance, and had to stop your chemo prematurely.  I’m glad you got a new job, albeit without health insurance benefits.  I was so sorry, and sad, to learn that your breast cancer has returned, is metastatic, and that you have no insurance. 

 I’d like to apologize for a member of our legislature, a health care provider himself, who an hour after your testimony stated publically that he didn’t want to hear anymore testimony from patients.  You see, his innate compassion for your situation is colliding with his anti-government ideology producing painful cognitive dissonance.  His only option is avoidance. 

 Perhaps, if you are still alive, you can sit down with some of the folks who are going to have to pay more for their insurance and help them find a cheaper cell phone plan, alternatives to cable Ty, or more affordable vacation options.  That is, of course, if you are still alive.

 To the woman who sat at my table at our governor’s health care summit.  I’m sorry I did not get a chance to meet and talk with you.  I noted that you are wheelchair bound, carrying portable oxygen, that the skin around your face was terribly tight, that you looked ill, and that you ate none of lunch provided.  It was only later that I learned about your terrible autoimmune disease, systemic sclerosis, and that you had no employment, no health insurance, and limited access to what you need to manage your illness. 

 I would like to apologize to you for our state’s legislators.  You see, the majority of them feel they are doing you a favor by not expanding Medicaid and thus preventing you from becoming dependent on government handouts and therefore motivating you to work and get your own insurance.

 Perhaps, before your terrible disease turns your skin and internal tissues into rocks, you could discuss household budgeting with someone who is employed, insured, making over 400% of Federal Poverty Level but is complaining about a premium spike.

 Finally, a shout out to the guy who sat next to me at the governor’s summit.  I’m sorry that you got multiple sclerosis, lost your job as an electrician, lost your union benefits, your COBRA lapsed, you lost your house, and your marriage failed.  It must be rather humiliating to now be living in your friend’s basement.  I was really impressed when you ambled over to the governor’s table, got past his body guards, and explained to him why you can’t afford the expensive medication needed to manage your MS.

 Let me apologize for the governor.   It has been nearly two months and he still cannot decide whether expanding Medicaid is good for our state’s citizens.  You see, he is fearful that the several hundred million federal dollars that our state will receive over the next few years will bankrupt the U.S. treasury and turn us into Greece.

 But hey!  Did you see the picture in the paper of our brand new nuclear aircraft carrier, the U.S.S. Gerald R. Ford?  What a beauty and soon to be carrier number 12 in the fleet.  I thought of you because although the federal government has already spent several billion on this state-of-art warship, they still need to spend a few more billion as they get her fitted out for sea trials.  I’ll bet they will need some cracker-jack electrician like you.  Maybe the governor could loan you the money to get your medicine and you could get working again.  Just don’t tell him how much the ship costs ($13 billion) cause we don’t want to worry him.

 Yes, the ACA is producing winners and losers.  But in my mind the financial setbacks facing the few losers are greatly outweighed by the improved health, prolonged life, financial security and access to affordable insurance available to the many winners.  It may never happen, but I hope  that those who think they have lost financially will someday see that the health insurance security that the ACA will establish in 2014…guaranteed access, guaranteed continuation, and guaranteed limits on out-of-pocket costs…makes us all winners.   The financial sacrifice by some is well worth the health insurance security gained by all.    

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