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.
Cindy Axne starts this month as a new United States representative from Iowa. She is the perfect spokeswoman for rural, middle-class, small-business citizens. I met her two weeks ago at a gathering in Des Moines; my daughter and her friend (both in their 30s) were in attendance and were sadly among the youngest present. This chasm of age is also important in regards to health-care coverage.
First, a digression. My wife and I just returned from an Iowa State University bowl trip in San Antonio. We traveled with good friends and were with 24,000 other Iowans supporting the ISU football team. Our friends are of Medicare age (65 years and older), and we discussed issues of prostate cancer and joint replacements. Because of Medicare, there was no talk of failure to obtain medical treatment due to lack of health-care coverage.
Yet, in my family-medicine clinic, I am continually treating patients age 64 years and younger who are in the throes of health-care insurance chaos. Those patients lucky enough to have health insurance are dealing with high premiums and a bewildering and always-changing set of rules regarding deductibles, co-insurance, prior authorizations, and drug formularies. If you do not have health insurance, then you are always walking the tightrope of having a medical condition that pushes you into either refusing to have medical treatment or bankruptcy.
Medicare is not perfect, but it is for Americans 65 years and older a safe harbor of health-care coverage. The truth is that Medicare is universal health care for this age group. This kernel of an idea allows me to return to Representative Cindy Axne.
Cindy and all Iowans will soon be barraged with an overwhelming number of Democratic presidential candidates who will tout the mantra “Medicare for All.” I will be happy to listen to their arguments when they come to Ames. But for now, in 2019 and in the political climate we shall have till the next general election, I still believe in working on incremental health-care reform.
My proposal for Representative Axne, which I have outlined in previous blog entries, is to allow individuals 55 to 65 years of age to buy into Medicare. If we can include the use of subsidies used for low-income individuals in the Exchange, I think we could argue that this proposal will help the health-care system in many ways. (See previous blog entries, including May 2016 and March 2017.) Most importantly, this proposal would take pressure off the private-insurance marketplace by removing the oldest and sickest set of patients, which would hopefully stabilize this market.
So, 2019 and Representative Axne, welcome to the world of health reform. I hope a year from now we can look back on positive accomplishments.
An explanation: My previous blog site was lost to my use, and that necessitated this new blog site. I look forward to working with you through this blog on achieving health coverage and good health care for our neighbors, friends, and relatives.