Health Care in the Heartland

USA! USA! USA! The crowd cheered anticipating the upcoming fireworks display off Arnold’s Park on West Okoboji Lake at twilight on this Fourth of July. Thousands of people on land, and hundreds more in boats on the bay, are all celebrating the birth of the land of freedom and opportunity. It is with this sense of freedom–specifically the freedom of speech, which on the same day the Des Moines Register reported it to be one of our most cherished freedoms–and with this sense of opportunity for the future that I start this blog dedicated to the improvement of health care in Iowa.

During the next 18 months, we will describe, evaluate, discuss, criticize, highlight, dissect, potentially improve, and hopefully at some point, complement the effects of the Affordable Care Act (ACA) on the residents of this great state. We will dig into topics of health care costs (our biggest problem), health care access, exchanges (now called marketplaces), Medicaid expansion, Medicare, competition in the private insurance market, health care manpower needs, independent physician associations, preventive health care and early detection, coordination of care (our greatest opportunity), government vs for profit vs not for profit health care, rural health care, and most important, the value and ultimate economic wisdom that occurs when individuals have health care coverage (to me, this is the essence of living in a land dedicated to freedom and opportunity).

As someone who, for more than 25 years, has been active in health policy issues in Iowa and nationally, I have witnessed and been a part of many efforts to improve health care; I have met many Iowans and others outside of Iowa who have shared with me their wisdom and visions of how health care could be made better; and finally, I have spent untold hours considering, as a family physician, geriatrician, and hospice director, who has had more than a hundred thousand patient-doctor interactions, how these theoretical ideas can affect the lives of actual patient.

For better or worse, I share some of this with you in this blog. For the better, I will ask some of these wiser individuals that I have met to share their own thoughts and ideas.

This blog will end on December 31, 2014, with a summary of how the Accountable Care Act has fared in Iowa. The next 18 months will be a watershed for health care. Iowa, as always, will be a microcosm for this unfolding of the future of health care. That said, let us get started.

Health Reform and the Economy

My premise for this blog is that the basic tenets of health care reform found in the Affordable Care Act (ACA) are sound. For years I have advocated for universal coverage, individual mandate, care coordination as a way to improve the quality and cost of health care, employer mandate (as limited by the ACA), improved private insurance competition, Medicaid expansion for adults below the poverty level, and improved insurance regulation. I will not say categorically that  every action found in the 2,000 page of the law is supportable, but by and large, I think it provides a framework that can produce positive, significant change and which, over time, can be improved as necessary.

This middle approach has unfortunately, sometimes left the ACA without strong support. The Right has castigated from the start–one Republican physician Congressman from the South told me that there was not one good idea found in the 2,000 pages of this law–whereas, the Left, favoring a public option and for some ultimately, a single-payer system, have not provided the vigorous response needed to counterbalance the din from the Right. Most important, the vast middle of the political spectrum has stayed out of the fray. The result is a law creating major changes on January 1 of next year, which is being undermined by poor public relations promoting the ACA, and by the Republicans using every effort possible to repeal and discredit it, allowing a great deal of misunderstanding and fear in the minds of the public.

At church this Sunday, the hymn being sung went, “in the land there is a hunger; in the land there is a need”. One of our country’s greatest hungers and needs is a reformed health care system. The problem goes to the heart of what is said in our Declaration of Independence regarding man’s desires for “Life, Liberty, and the pursuit of Happiness.” Separate from the loss of life that occurs daily due to individuals not having health care coverage, I want to discuss the loss of Liberty and the pursuit of Happiness. I believe President Obama has is somewhat wrong when he said that individuals with private coverage (the vast majority of working Americans) would be happy to keep their current insurance. Through my years of taking care of patients, I have learned of many incidents where a patient is trapped at a job because they need for health care coverage for themselves, their spouses, or their children due to a chronic health condition. Near universal health care coverage, I guarantee, will allow thousands of individuals to quit their corporate jobs and either find employment with a new firm or start their own company; separately are the untold thousands who would quit their jobs to enjoy early retirement. One of the great secrets in the effects of this law is the economic boost the United States will receive from these individuals leaving their jobs, allowing them to pursue new opportunities while others can then take these jobs.

Beside sharing my thoughts and the thoughts of others on this blog, I will make available to you my years of collective thoughts regarding health care. It may take on several forms of communications media that I will place in categories of interest. In the meantime, I look forward to sharing my thoughts and ideas with you.