The Health Care Bill: A Doctor's Point of View

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Like all bills, this one has a bazillion little loopholes, asides, and sneaky little buggars. Plus, it’s hard to boil down something so big to bullet points. I’m sure I’ve left things out and maybe even gotten things wrong, but here’s my understanding of the new health care bill.

Stethoscope on Indian banknotes of different denominations

  • Universal health care will not exist, but the new bill aims to reduce the number of uninsured people in the US by 32 million by 2019. 23 million will remain uninsured, most of them illegal immigrants.
  • Eligibility requirements for Medicare and Medicaid will expand, allowing more people to be covered by government-sponsored public aid. Anyone earning less than 133% of the federal poverty level will be eligible for Medicaid.
  • Anyone earning between 133% and 400% of the federal poverty level will be eligible for a sort of sliding scale that will cap the cost of health insurance premiums.
  • Most Americans will be required to carry health care insurance. Failure to do so will result in a $695 (or 2.5% of taxable income- whichever is highest) penalty.
  • Employers with more than 50 employees will be required to offer health insurance. Smaller companies who choose to offer insurance coverage will be offered tax breaks.
  • Insurance companies will no longer be allowed to discriminate against you based on pre-existing health conditions, and they will not be able to charge more for your premiums if you are sick. They will also be forbidden from dropping your coverage should you become ill.
  • This will cost American taxpayers $938 billion over the next 10 years. Half of this expanse will be paid for by spending cuts, while the other half will be financed by higher taxes. The bill is expected to reduce the federal budget deficits by $143 billion over the next 10 years.
  • What Do I Think?

I am a doctor, but I am also a woman with a husband and child, a consumer of health care, an employer, and a taxpayer. My thoughts on President Obama’s administration’s new health care bill take into account all of these roles I play, so I’ll share my thoughts based on which hat I’m wearing.

Doctor

As a doctor, I have watched my feelings about health care reform change over time. When I was younger, I feared government intervention into health care more than I supported it. Who wants some bureaucracy telling me what I can and can’t do with patients? But the truth of the matter is that physician autonomy has already been so compromised by managed care that it can’t get much worse. So my feelings have flip-flopped on this issue, as have the feelings of almost every doctor I know. Yes, I live in California, but at least here, I am not alone in my support of universal health care.

In light of that, I am disappointed in this administration. I know they did the best they could, but I don’t think it’s enough. Like many other doctors, I have lost all faith in private, for-profit health insurance, and I believe that our broken health care system will not begin to heal until we eliminate insurance as a business that is raping the American people (breathing deeply to keep my blood from boiling, so bear with me.)

I also think that any health care reform bill must reform our legal system. Keep in mind that I am a doctor who has only been sued once. My one lawsuit came from a woman who swears I stole her labia. (Yes, you heard me right. She took me to court three times, and I had to defend myself in front of a judge and explain myself to the California board and every insurance carrier. And don’t worry. All her paranoid schizophrenic parts are right where I left them.) Any system that forces me to pay outrageous sums of money to lawyers and malpractice insurance companies and go to court to fight something so ludicrous is dangerously flawed. Yes, there are unethical doctors who make dangerous mistakes. And yes, they should be punished. But with all due respect to lawyers (some of whom are my best friends), the blood-sucking ambulance chasers simply have to go. Accept a little personal responsibility, people.

As a doctor who spent a dozen years serving the uninsured in emergency rooms, I see how lack of preventative health care leaves people broken, bleeding, and only able to receive health care when they wind up with life-threatening emergencies. I believe health care is a right, not a privilege. All Americans should be granted the right to good doctors, services, and disease prevention and treatment. Period.

But hey, the health care reform bill is a step in the right direction. I continue to have hope.

Mother and Wife

I do not have life insurance, and I am the primary breadwinner for my family. So it comforts me to know that- should my husband and daughter wind up without me to help support them- they might be eligible for government assistance that will ensure they receive health care.

Health Care Consumer

My family has always been blessed to carry health insurance. Frankly, right now, we can’t afford it. Because I quit my fancy six figure job and am now self-employed and building a business from scratch, we’ve been on Cobra health insurance and are approaching the three year limit. We must get new insurance. But my husband and I both have preexisting conditions, and the private insurance we tried to get turned us down, even though we’ve had continuous coverage our entire lives. It’s criminal. So we pay $1000/month for insurance we can’t even use because we no longer live near the city where we are insured by an HMO. So basically, we’re only covered for catastrophes. Which pisses me off.

Maybe this new bill may help. If insurance carriers aren’t allowed to discriminate against us, we might wind up with insurance we can use. Yes, it may cost us even more, but at least we might be able to use it.

Employer

Owning Pink only has a handful of employees and will not meet the 50 employee limit that would require us to offer health insurance to our employees, but we are already looking into being able to offer that option to our employees, not because we have to, but because it’s simply sacred commerce. I care about every single one of my employees, and should something happen to them, I want to rest assured that their needs will be met. If this means a greater portion of the profits I know we will someday make goes towards nurturing those who work for us, so be it. It’s worth any price to know that my fellow Pinkies be able to OWN their health.

Taxpayer

Yes, it’s crazy expensive. Yes, I worry about making government too big. Yes, this will affect me personally. I will be in that higher tax bracket that is sure to get hit. That means fewer luxuries, less money toward saving for my daughter’s future, and fewer resources to put into growing our business ventures. There will be less money to pay back our debts, less to invest in retirement, and fewer dollars to spend on helping start the Owning Pink foundation, which will help fund Pinkies who wish to take our workshops or receive health care through our practice. But it’s worth it to me to give up some of my personal financial security in order to serve the world. People deserve to be healthy. It’s the first step towards being vital and getting your mojo back.

My Gestalt Feeling About The Whole Shebang

I’m disappointed that universal health care remains but a pipe dream. I’ve been a supporter of universal health care since Hillary Clinton pushed for it, long before it was popular among doctors to support the idea. (FYI- my Dad is rolling over in his grave because I just wrote that, God rest his Dr. Daddy soul.) But I feel a ray of hope that this is the first step in that direction. Frankly, I think insurance companies and lawyers have ruined the whole health care system, and until insurance is not for profit and until we manifest effective tort reform, we’re spinning our wheels. But hell, it’s something. So kudos to Obama for taking a stab at it and rallying the troops to make two steps forward.

Lissa Rankin, MD is the founder of Owning Pink and author of What’s Up Down There? Questions You’d Only Ask Your Gynecologist If She Was Your Best Friend (St. Martin’s Press, Sept 2010). She is also the founder of the Owning Pink Center, an integrative medicine center in Mill Valley, CA, committed to helping you live a vital, whole life.

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