During the Golden Age of Journalism, S.S. McClure, editor and publisher of McClure’s Magazine, who is credited with developing some of the best journalists of the 19th century, said, “The vitality of democracy depends on popular knowledge of complex questions.”
Complex questions are currently before the public involving health care, and, specifically, the unfolding and future of the Affordable Care Act (ACA) or Obamacare are clearly among the most complex questions our society faces.
Celebrate! I celebrate the birth of my granddaughter and the birth and growth of CoOportunity Health. This week, as I drove with my wife and my 2-and-a-half-year-old grandson across the city of Des Moines so we all could meet my newborn granddaughter, I pondered the emotions involved with parenthood: the pride that — even as a grandparent, with only a small part in the creation of this tiny, new life — is still an overwhelming emotion, responsibility, joy, and sincere thanks. Each of these emotions fill a parent, grandparent, or godparent. At the baby’s birth on Tuesday evening, May 27, I was so moved and will continue to be throughout this beautiful child’s life into her adulthood.
In previous blog posts, I have attempted to highlight the absolutely critical need for a functional, user-friendly Exchange for Iowa as outlined in the blueprint for health reform that the Affordable Care Act (ACA) laid out. Iowa’s failure, at the beginning of the ACA process, to establish an Iowa-exclusive Exchange — an Exchange operated by Iowans for the exclusive enrollment of Iowans — resulted in a hybrid or partnership between the state of Iowa and the federal Exchange (www.healthcare.gov). The results of that partnership have been neither reliably functional nor user-friendly. On Monday, March 31, I met with members of Senator Tom Harkin’s staff in Washington, D.C., and presented to them the following proposal. The proposal is self-explanatory. Since then, there are reports that the state of Iowa has applied for federal resources from the Department of Health and Human Services to plan for a state-managed, state-government-operated Exchange.
Words, at one time or another, have a profound impact on us. As I have watched some of the television commercials currently running and that will, undoubtedly, continue to run, paid for by out-of-state entities, falsely describing the Affordable Care Act (ACA), most often referred to as Obamacare, one word came to mind: reprehensible. Reprehensible is an adjective that declares something morally wrong, evil or disgraceful. My wife added that it seems also to imply the term dastardly. Both words are consistent in describing these too-often-seen commercials.
These commercials imply that the ACA has exorbitantly raised insurance premiums for individuals and denied others the opportunity to renew their insurance policies from last year. This is simply not true when applied to the effects of the ACA in Iowa.
In one of the most profound lectures that I have heard in my life, Dr. Eric Cassell, New York City internist and author, discussed at a Harvard conference on hospice the “Nature of Healing.” His concept regarding spirituality moved me. He said, “Function reaches from the cellular to the spiritual. Something is spiritual when it transcends the individual. Relationships are spiritual. Religion is spiritual. Spirituality is a human function.” As a family physician, I fully subscribe to this spiritual aspect of my relationship with my patients.
Jim is a 56-year-old man with diabetes who has been my patient for several years; he is a subcontractor in the construction field in a county seat. (I changed his name and those of others whose examples I cite in this blog.) He is divorced with grown children and is devoted to his grandson. He has been uninsured for years due to his medical problems. Starting January 1, he will have health insurance through the Exchange, which allows people to explore subsidies and to compare and sign up for plans. An insurance agent who would not have had any options to offer my patient last year drove to Jim’s home twice from metropolitan Des Moines to set him up with his new policy.
(Given as testimony on November 19, 2013, to the Iowa Legislature’s Integrated Health Care Models and Multi-Payer Delivery Systems Study Committee)
The Holy Grail of health reform is controlling costs while still providing access and quality. In my mind, the key to finding this Holy Grail is care coordination, forms of which can include patient-centered medical homes (PCMHs) and accountable-care organizations (ACOs). As a former member of the federal Advisory Board for the federal health-care Consumer Operated and Oriented Plan (Co-Op) Program, I helped write recommendations regarding “integrated care,” which was a legal requirement for becoming such a co-op. Our Advisory Board recognized both PCMHs and ACOs as reasonable forms of “integrated care.”
(This month’s blog post is the text of an article that I was asked to write for a professional publication.)
As chair of the Iowa Tobacco Use Prevention and Control Commission, I was responsible for helping to guide Iowa’s anti-smoking efforts by following a mission statement created by the Iowa Legislature that read, “to foster a social and legal climate in which tobacco use becomes undesirable and unacceptable.” In this same vein of using legislation to create social change, I will review the actions derived from the Affordable Care Act (ACA), also known as Obamacare, in Iowa. From this family physician’s reading of the ACA, I submit that the underlying social change goal is to create a “culture of coverage,” which means that, within certain constraints, the citizens of the United States, and residents of Iowa in particular, will have the expectation that they have health coverage and that they will, in part, be responsible for securing that health coverage.
Obviously this 2,000-page law has many more elements, approaches, and objectives, but for me, this “culture of coverage” is the overarching goal. It is with this goal in mind that I discuss what I perceive as the unfolding of the ACA in Iowa.
Two renowned world leaders have offered “facts” in famous quotations that have bearing on the state of an Iowa health-care Exchange.
Prior to the American Revolutionary War, John Adams, one of our most famous patriots, took on the controversial role of defending British soldiers who had fired on a Boston crowd of protesters. In his successful legal defense, he uttered the famous statement, “Facts are stubborn things.”
In 1993, during the Clintons’ attempts to create health reform, the Iowa Academy of Family Physicians came forward with the Principles of Health Reform (present in archives), which I helped to write. Number one and the most important principle was that individuals should have the peace of mind of knowing they and their families have access to affordable, comprehensive health care.
Failing in that effort in the early 1990s to achieve broad health reform, as Senator Tom Harkin would tell you, Congress and individuals throughout the country sought to make incremental improvements in the system. One of the major efforts was made in the area of children’s health care. During that time, the Healthy and Well Kids in Iowa (HAWK-I) program was conceived, developed, legislated, and passed into law. Working on that effort, I wrote a piece published by The Des Moines Register (present in archives) that described a child arriving at school with a cut held together with rags and electrical tape because of the family’s inability to afford health care. I would submit that that parent did not have peace of mind regarding his or her child’s health.