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The Day After Tomorrow… and tomorrow… and tomorrow

By Lindsey Shultz
. 1 Comment(s)

The official opening of the online marketplaces created under the ACA was highly anticipated- and not without its glitches, in the best sort of way.  After months of foreboding press about how 80% of the uninsured didn’t even know about the healthcare exchanges, let alone whether they would sign up for coverage,  websites and call centers were inundated across the country. 4.7 million unique visitors went to, the portal for individuals and small business owners to find out their options under the new insurance program.  For some, this resulted in long wait times or spurious website access.  For others, it highlighted institutional gaps that exist for at least 15% of American adults- lack of regular internet access.  

My day began with trying to sign my father up for an account on the federal exchange, as he lives in a state that has chosen not to run its own.    The first challenge we encountered, on the first page we went to:  him sitting in silent confusion for a moment then saying “What’s an email address?” It was then I realized that this might take a while.  And here’s the thing- that’s ok.  October 1st was just the beginning of a 6 month enrollment period, of the first year, of what will become a program integral to the fabric of our social structure, just like Medicare and Medicaid. These programs (among others) have become  interwoven into our concept of what we as a society value and think deserves protection from the unpredictabilities and vicissitudes of both economic downturns and political volatility.  The Affordable Care Act is just beginning the social and symbolic work it will do- both over the next year and the next decade.  

And Americans understand this- and can be a patient people, which might surprise some of the commentators and pundits who edged toward forecasting failure after technical challenges in the roll outs.  But sites were overwhelmed by a pent up demand for affordable health care coverage, a desire by millions across the country to provide financial and emotional security for themselves and their families for the time when (not if) they next find themselves in need of medical care.  A narrative emerged from a panoply of community centers and doctor’s offices that people trying to sign up were eager, and while disappointed with some of the wait times, willing to wait.  For the savings, and sense of security, some were willing to wait all day.  Or perfectly willing to come back next week.  Or the week after. Plans don’t kick in until January, and for people who may have been waiting for coverage for years- a few weeks more, after which they will have the same coverage the rest of us can enjoy, feels pretty reasonable.  As one official said, this is not a sprint, it’s a marathon.  But for the 5700 people enrolled as of today, it’s a marathon they’ve already won.

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  1. Angela Walker MD MPH

    Civic engagement is not for wimps or the faint of heart.
    Recently, here in Kansas, I was interviewed by a public radio reporter and I asked him not to use my name for fear that what I said when and if broadcast would get out to my employer and I would lose my job or my co workers would look down on me as a demon or a sinner or devil worshiper.

    In the community where I am presently working, I have met with patients who are veterans of the wars in Iraq and Afghanistan. Some of them have told me that they are unable to get food for their families. Some have said that they are unable to afford prescriptions despite get some VA benefits.

    I am appalled because they are white! I used to think this only happened to African Americans and Latinos particulary urban people. But I am working in a rural area not far from the capital of Kansas.

    The lack of affordable health care is a major public health problem. When a family loses their home because they could not pay for care, it is a wonder why the US is sending billions of dollars to the middle east, Afghanistand and Pakistan.

    We are in a crisis that has little to do with anything other than we are living not in a democracy, put a meritocracy or for that matter a plutocracy; meaning others put values of worth of individuals based on not their humanity, but rather their worth in making and keeping the richest 1% of the country rich and everyone else beholding to them.

    Those that are opposing affordable care are insulated from the facts that health care costs and spending has a lot to do with who gets a heart transplant versus who get dialysis versus who gets medications.

    Health care is the only service today which people use but do not know what they are paying for until they have used the service, hence getting a bill. And if they can't pay, it works against their credit or they can lose a home.

    The hospitals systems are mostly to blame for this, not physicians. Remember that in the seventies and eighties the concept for hospital expansion was "if we build it, they will come". Malpractice insurance is also to blame. A physician today can't even get a license without insurance. The pharmaceutical companies get tax funds to develop drugs that they charge the taxpayers millions more in return for those drugs, albeit fooling the public into believing those expensive drugs are the only game in town to prevent, slow the progression or cure disease.

    Health care has become a money free for all for the financially well connected through the insurance industry and the banks and whoever has the funds to bankroll it all.

    There is better way and the Affordable Care Act is just one step in the right direction to fight the sky rocketing cost of health care.

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