Martin Luther King once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Sadly, this remains true today. Instead of simply providing the care one needs, access to care varies based on wealth, status, and the type of insurance product a person has. I have been working as an emergency physician, health services researcher, and leader in health care for over 30 years. I have dedicated my entire career to providing care and helping others. Our current health care system’s incentives and goals are neither what we as a country expect nor want. We expect and want a health care system that provides great and affordable care; the health care system we have expects and wants to make lots and lots of money. People from both sides of the aisle cannot seem to agree on health care legislation and reform that will work for both the patient and the provider. Rather than propose a set plan or piece of legislation, I will instead describe an overriding set of guiding principles. I will describe three fundamental principles that we can use to guide the conversation and to set up a process for improvement and change. Health care should be: Universal, Simple, and Accessible Universal health care When we say that health care is “universal,” does that mean “Medicare for all,” “single-payer health insurance,” “socialized medicine”? These slogans have become polarizing, and their use often keeps us from working together. Universal health care means health care that covers and cares for everyone. When we get sick or are injured, our care should be universal. The health care system should care for us in the hospital; it should care for us when we go home and care for us as we recover. The health care system should give us access to providers, home care services, and the medications we need. Federal legislation called EMTALA ensures that all who arrive at the emergency room doors will be seen and cared for. But who pays for that care when a person does not have insurance? The current health care system may try to help a person get insurance, but we all pick up the cost as charity care if they fail. We can do better. This great and wealthy nation needs to provide comprehensive low-cost health insurance to all. Anyone below the poverty level is eligible to receive state-based Medicaid, but should a person start working, Medicaid is automatically cut off. This is punitive — the wrong “stick” at the wrong time. I propose extending Medicaid to 400 percent of the poverty line to bridge “new to the workforce” or “return to the workforce” workers who need care, a proposal that would help workers and employers: employers would have workers with health insurance and workers would not have to worry about copays or deductibles. Case in point: During the early days of the pandemic in Philadelphia, I diagnosed Miss W with COVID and recommended that she stay in the hospital for a few days to make sure that she improved before going home. She declined. She worked two jobs (caring for older adults), she had two school-aged kids to care for, and she had a deductible of $9,000 on her health plan that she purchased from Pennie (Pennsylvania’s exchange). She simply could not afford to stay in the hospital. So, we devised a plan where she would receive daily text messages checking on her oxygen level, and I advised her to wear an N95 mask and social distance as much as possible. In so many ways, Miss W. was doing everything “right.” She worked hard, provided for her kids, and tried her best. Miss W should have Medicaid coverage with no deductible. We can do better. The current system also fails self-employed or contract workers. Those whose income is greater than 400 percent of the poverty line (over $80,000/year) should still have access to plans provided on the health care marketplace, and the cost of those plans should be pre-tax with no deductible or copays. Buyers should also be able to purchase state Medicaid plans across state lines. Let’s not forget that some people have great employer-based health insurance that covers everything, including the cost of prescription drugs. If a person likes their health insurance, they shouldn’t have to change their coverage. They should be able to keep the doctors and hospital care they have. But for older adults in our society, Medicare should be universal and all-inclusive. When a person turns 65, they should be covered completely–no supplemental costs, no copay, no prescription drug costs. The current Medicare system is complicated, not comprehensive, and the supplementals cost far too much. At least four hours per day of skilled and unskilled homecare should be included as part of standard Medicare benefits. These improvements to Medicare would improve the lives of patients and their families. They would also prepare for future expansion to cover people 55 and over. The changes I have outlined above seek to meet the fundamental principle that if a person has health insurance it should cover all their health care costs; coverage is not Universal if it costs them additional money to get the care they need. Simple health care When people receive care, that care needs to be paid for, in full, without hassles or runarounds. I say no denials, no mediation or negotiations, no bills, no additional payments, phone calls, or endless waste-of-time-and-money fighting for something they already pay for every month! When they need care and support their family and their loved ones, they should get that care, and their insurance plan should pay for it. It is just that simple! Case in point: I met a woman in Lycoming County after giving remarks at their Democratic Summer Picnic. She thanked me for advocating for services for people with “dual diagnosis” — mental health challenges and substance use disorder. She cried while talking about her struggles trying to get help for her 25-year-old daughter. The expenses, the denials of care, the endless phone calls, the bureaucracy, the bias, the lack of understanding (many people with mental health challenges also have some substance use history or ongoing needs)—all she’s ever wanted is care, housing (with social worker and certified recovery specialist (CRS) support) and love and understanding. Instead, the current system has given her denials, life on the street, and even incarceration. We can do better. Accessible health care If any provider or hospital receives even a single dollar of Medicaid or Medicare funding, then they should be legally required to take, for full payment, any patient’s health insurance product. That seems like a simple concept, but getting it into law will be hard. The powerful and wealthy lobbies will fight against it, but that is OK, because it is the right thing to do. The principle must be that if a person needs care, (specialty, mental health, primary) that health care should be accessible in their community by a provider of their choice, period. Case in point: When I think about access, I think about a story I was told about the mother of a woman I met in Dauphin County. Her mother had advanced kidney disease and needed dialysis. Her mother had insurance but was unable to find a specialist at her local hospital who would take that insurance. She ended up having to go to emergency rooms in order to get the dialysis treatments she needed three times per week. We can do better. Closing These fundamentals are meant to be an outline, a bold starting place for discussions about how to make our health care system better for patients, for the people of this great nation. My hope is that we can get enough leaders on both sides of the aisle to openly and honestly discuss the principles of universal, simple, and accessible health care and drive towards solutions as we move forward as a Commonwealth and as a nation. Source
