The Healthcare Paradox

Do we really need comprehensive healthcare reform? Is it a right, privilege, or just a pipe dream for those who cannot afford it or even worse, a crutch for the politicians to build their careers upon by rooting for or against depending on their lean, loyalties or the general direction of the wind?

I have always considered myself to be a staunch supporter of the first. I believe that it is a right; not the health insurance per se, but the availability of affordable care without worrying about total financial ruin.

I am also a staunch supporter of quality and low cost education, and hence rapidly becoming a member of the third group with a pipe dream that is as out of reach as a ban on lobbies from Washington and term limits on congress. I do not believe in such rights because I am a socialist, or even worse, a politician with an agenda, but an academic healthcare provider who believes that America will not be "Great", or "Whole" again unless we secure these basic necessities for the next generation of great American innovators, thinkers and leaders.

Spending the past 17 years, tending to the needs of the underserved population of the county at a safety net clinic, and training our next generation of physicians in two institutions who share the same vision of bringing quality healthcare to people at the basic level, I have seen, first hand, the devastation caused by the lack of, or limited access to basic healthcare and quality education.

In theory, healthcare reform makes perfect sense. I may be one of the fifty percent in the middle and left of the great American divide who believe that to ensure availability of quality and affordable healthcare, whether a right or a privilege, squarely falls into the lap of the government.

Even if we need the private sector to fill the need, strict regulation of their business models is not only required, but vital to the success of this mission. Unless we achieve that and stop listening to special interest groups, the results will not change. Whether we are dealing with healthcare reform or an overhaul of our higher education system, we need to let go of our partisan blinders and reach across the aisle to achieve our common goals.

Special interest groups, lobbies and corporations need to be eliminated from the discussions as the conflict of interest is blindingly obvious and frankly, disabling. As a physician, I am not allowed to receive a pen from a pharmaceutical representative as that small token of advertisement somehow holds the power to sweep me off my moral ground, while billions are spent in Washington by lobbies and are somehow powerless on the same politicians who passed such laws because in their minds, physicians were easily corrupted by a mere pen or post-it pad. Am I the only one who sees this contradiction?

The end result of all this is a system, which looks good on paper but does not deliver. While, one is free to buy insurance from the marketplace (as long as one perfectly times their financial strength to coincide with the enrollment period), the plans are nothing but a glorified parlor trick. So, for example, in Pennsylvania, if you are a family of 1, you can receive Medicaid if income is less than $16,000, however, if you are in a red state that has not passed the Medicaid expansion bill, you do not qualify for anything.

If you make more than $47,000, there are no tax credits and you have to pay the whole premium for an insurance plan. This amount goes up so the number is $97,000/year for a family of 4. Premiums can be anywhere from $350 for a bronze plan to over $1000 for platinum plan a month per person. Since these are not group plans, the numbers keep getting higher and higher with increasing deductibles and out of pocket costs; most of those insured in the bronze range end up paying all of their costs out of their own pockets without truly availing any payments from the insurance.

The only true benefit is that they are charged the contracted rates as opposed to the ridiculously high rates from the Master Charge list reserved for the uninsured. Legal immigrants who are in the country less than five years are in an even deeper mess. If their household income makes them ineligible for a tax credit, they have to go to the marketplace, however, unlike others, if their income is less than $16,000 or they are over 65, they are ineligible for Medicaid or Medicare respectively, even if they choose to pay for them out of pocket. Elderly immigrant parents of US citizens end up without any health insurance and end up becoming a burden on the healthcare system. Even if they can afford some form of health insurance, their deductibles make their situation unaffordable and many choose not to pay the premiums, relying on fate and possibly state funding in case of a catastrophe.

We would not be here if lawmakers had thought about the people they serve rather than the people who fund their campaigns. This is not a red or blue issue. This is an issue that extends across the aisle. Each year that passes, we are closer to a precipice. Our healthcare costs are skyrocketing while people are increasingly unable to afford them. Our college education is rapidly becoming a fantasy for the middle class, marking the beginning of an end where innovation will fail to be nurtured. We are witnessing an expanding bubble that can burst at any moment and if we are not prepared with measures to strengthen its foundation, we are in for a bumpy ride.