As a family physician and health-care advocate, I have fought for universal health-care access for more than 25 years.
In 1997, I advocated for the proposed Healthy and Well Kids in Iowa (HAWK-I) program by writing in an op-ed that a “child with a laceration on the arm goes to the school three days after the injury happened. The wound is held together with a bandage of rags and electrical tape. The child has no insurance.”
Three weeks and 1 hour ago, I ruptured my quadriceps tendon (tendon above the kneecap (patella)) while playing tennis. Five hours later, my quadriceps tendon was surgically re-attached to my patella using three drill holes and wire sutures. The surgeon said, upon opening my knee, that it looked like a “bomb” had exploded. I can sympathize with that statement because, for two weeks after surgery, every step with crutches felt like an explosion had occurred again in my knee.
I last wrote to you regarding health care in Cuba after a cruise there earlier this year. Interestingly, that cruise has now been banned by our president. Now, six years to the month since I started this blog regarding health-care reform in Iowa, we have 24 Democratic presidential candidates crisscrossing the state and most of them on a national debate stage raising their hands regarding whether the country should eliminate private insurance in lieu of a Medicare for All proposal.
After four days in Cuba, seeing much countryside and touring three cities – Cienfuegos, Havana, and Santiago de Cuba, I have some reflections regarding health care, there and here in the United States.
As my Health Reform blog returns in a new format, I wish to comment on two more significant startups — a new year and a new 3rd District congresswoman from Iowa. In relationship to health reform, by which I mean improving health-care coverage for Americans and especially Iowans, I think these new developments have meaning.
In Iowa, a new year will start with health costs continuing to go up, the individual insurance market pricing people out of the ability to have health insurance, a state-legislated health-association insurance plan that legally allows for the discrimination of individuals with pre-existing conditions (further perverting the individual insurance market), and a besieged Medicaid for-profit managed-care scheme that will continue to reward these companies’ shareholders at the expense of Iowa patients.
I have just read Walter Isaacson’s biography of Benjamin Franklin, Benjamin Franklin: An American Life, and was struck by Franklin’s “great rallying cry for the new American middle class,” according to the author, or, as Franklin in his pamphlet, Plain Truth, said, “We the middling class people. The tradesmen, shopkeepers, and farmers of the province and city!” I contrast this emphasis with the recent Iowa Democratic gubernatorial debate and the five candidates running in next Tuesday’s primary and separately this past Wednesday, when Governor Kim Reynolds signed Iowa’s new tax-reform law.
2017. The year health reform took it on the chin. The year the middle-class, individual health-insurance buyer was abused by President Donald Trump and the entire Republican Party.
In Iowa, where we almost had no insurers in the individual market, we were left with one for 2018, Medica. One is not a choice. Who knows whether we will have insurers in 2019.
I stood in line at 6:45 Sunday morning to purchase donuts at a very popular local donut shop — Spudnutz — at Lake Okoboji. The line of donut-seekers stretched far out the door. I did not receive donuts until 7:50 a.m. I waited more than an hour for donuts. (Yes, very good donuts). Nine people were working in that donut shop that once housed an auto mechanic shop.
If either the Senate bill or the House bill that was intended to repeal and replace the Affordable Care Act (ACA) became law, I fear none of those nine hardworking people would have health-care coverage in the future. For many of my patients and for, I believe, the employees of Spudnutz, I give thanks for the defeat of the Senate “skinny” repeal legislation.
In 2003, Iowa used part of its portion of the 1998 Tobacco Settlement monies to help build a new Supreme Court Building. During those years and later, Iowa Republican legislators sought to reduce the funding and scope of the Iowa Tobacco Use Prevention and Control Commission, which was created to use the settlement monies to help Iowans to either quit smoking or not start. I said at that time that using the Tobacco Settlement monies for any use other than health care was wrong. As a former chair of the Tobacco Commission, I viewed this money as blood money because it was being paid out to partially compensate for the death and disease that cigarettes had caused Iowans for many decades.
Similarly, I use the same term, blood money, today regarding the U.S. Republican House and Senate efforts to repeal and replace the Affordable Care Act with a plan that will reduce wealthy individuals’ taxes by more than $600 billion over 10 years by taking a similar amount of money from the Medicaid program and from subsidies used to supplement poor and low-income individuals’ effort to pay for premiums in the individual health-insurance market.
Last week, the buzz in Washington, D.C., where I heard numerous lectures and personally talked to two U.S. representatives and two U.S. senators, was about impending health-care legislation in the Senate and particularly focused on the imminent crisis in Iowa, where there probably will be no insurers for the individual insurance market in 94 of its 99 counties in 2018.
Seventy thousand Iowans may not have health insurance next year in a state that prides itself as an insurance state. Iowa is the poster child for the deficiencies in the individual insurance market. Across the nation, only a few counties in Tennessee have that known potential for 2018, though several potential fixes are being discussed at the federal and state levels.