Medicare for All and the Elimination of Private Insurance

An Iowan’s Plea for Honesty to Democratic Presidential Candidates

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.

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Health Reform: 2019 and Representative Cindy Axne

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.

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Health Reform and Iowa’s Next Governor

(These are remarks I gave to an audience of 50 Iowans introducing Fred Hubbell, Iowa’s Democratic candidate for governor, at my home on Saturday, June 30. This is belatedly posted here because of technical difficulties with the blog site earlier in the year when these remarks were more timely.)

My wife and I welcome you to our home and are very happy you are here today to meet, greet, and support Fred.

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Health Reform and “We the Middling People”

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.

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Health Reform and Primum Non Nocere Revisited

Several months ago in this space, I discussed my concerns about a Trump presidency regarding the Latin phrase “primum non nocere,” which means “first do no harm.” Now, at the end of the 2018 Iowa Legislative session, I revisit this phrase to discuss my concerns about the results that this Republican-dominated Legislature and the Republican governor have created or are creating.

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Health Reform and Mental Health

School shootings and other mass gun murders, the opioid crisis, homelessness — these social ills all could be improved with adequate attention to the mental-health infrastructure in America. What is missing in most of this current national discussion is that mental-health evaluation and treatment should be a primary part of the solution.

As a family physician, I contend that mental-health evaluation and treatment is too late if we only concentrate on the prospective shooter, the addict, or the schizophrenic person who is living on the street. Do not misunderstand me: We need to help these individuals. What I am specifically saying is that we need to help them, as well as the vast number of people with mental-health diseases, when the diseases first occur or even before they occur.

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Health Reform and Myalgic Encephalomyelitis

For a few days of my recent vacation, I was laid low by a viral infection that included, along with other localized symptoms, overwhelming tiredness and emptiness. That ennui that I felt to my bones was all-consuming. I have recovered, thankfully. Regarding the malaise that I had for a few days has given me greater empathy for two of my patients who have had a similar malaise for years. These two patients, who were independently diagnosed, one at the University of Iowa in Iowa City and the other by a national expert in North Carolina, have a condition now called myalgic encephalomyelitis (ME).

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Health Reform and $2,000 per Month Health Insurance with a $10,000 Deductible (which Is Only Going to Get Worse)

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.

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Health Reform and Continuity of Care

In the chaos of health-care efforts both nationally and in Iowa, today I seek to go back to two basic beliefs: 1) the hope of future generations to learn from past generations’ mistakes and 2) the value of continuity of care for primary health care and, ultimately, health care in general.

The U.S. Senate is now debating a tax-cut bill that includes eliminating the Affordable Care Act (ACA) individual mandate for health-care coverage — a basic tenet for true health-care reform — and, in Iowa, the for-profit, managed-care Medicaid fiasco now has one managed-care organization (MCO) leaving the state and another MCO not able to take new patients. These actions leave the state with only one MCO left to serve Medicaid patients. Given these realities, I shift gears by presenting to you a guest blogger.

She is a third-year medical student who recently spent a month with me in my clinic. She plans to be a pediatrician. I choose not to provide her name. Although she would allow it, I am not sure her medical school would.

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