I don’t usually get all political up in here. It just isn’t my thing. I have read countless comments on Facebook about the Supreme Court’s decision about the Patient Protection and Affordable Care Act. That shit is everywhere. And everyone has an opinion. “Everyone is entitled to healthcare…” Yeah, okay. Great. Kumbaya, and all of that jazz. If you are disadvantaged and need medical coverage, and there is a way for you to get it, I am all for it. We have programs like that in the U.S. We have for decades. Yes, they suck a little more than the insurance one pays for electively. If I am out of food, and I go to a food bank to get food for my family, the items I get, though appreciated, are not of the same quality I would buy if I went to the grocery store and shopped for myself. You take what you can get. I’m sorry to sound so blunt, but it’s true.
I’ve said it before and I am going to say it again: I used to not have insurance. John worked at a job that paid him $8/ hr. and the benefits were almost $700 per month. Evan was a newborn. So I took an eq\ually crappy job as a housekeeper at a hospital where the insurance was about $400/ month. I essentially worked for the insurance When the income got to be too little, I went to work on a degree that would pay me what we need, both in income and in benefits. And I’m not afraid to give you the straight dope, though it is poor etiquette. I gross over 8 thou a month. I bring home about 4K of that. What???? Why? Well, simple, really. I pay over half of my income on taxes and pesky little necessities like medical, dental, and vision insurance. Right now, that is the lay of the land. It is how the shit falls.
So while I am not too keen on spending even more of my very hard-earned money to support those who did not have the wherewithal to go out and do what I did–find a beter job, better benefits—I simply cannot afford it. I am not living high on the hog. We have one car. My husband rides his motorcycle in good weather to save on gas. We try to limit our dining out these days. I clip coupons. We live in a house that is way below our means because it is cheap despite being in a nice, white-collar neighborhood. And though I am off for my neck and shoulder right now, I work every God-forsaken hour my employer will allow me to work in order to make more, to pay more in taxes…you get the drift. I cannot afford more of my tax dollars to go to support your healthcare. I will take care of you when you are ill. I will risk contracting any infectious disease you are carrying because someone has to. But I am not willing to sacrifice the well-being of my children to pay for you and yours. I’m sorry.
And there are other misgivings I have about PPACA. This part is coming from a healthcare professional who works in the trenches, from someone who is wrapping up a degree in business \with a concentration in healthcare management. Hospitals rely on reimbursement. They do. The naional average for Medicare and Medicaid reimbursement revenue is around 60% of hospital revenue. The hospital I work for receives about 80% of their revenue from Medicare and Medicaid. That’s a big ol’ piece of the pie. The pie that determines the amount they can do for their community, the services they provide to their patients. And guess what! For added fun, those coffers are getting pretty shallow. Hospitals are fighting harder for less dollars. And we can expect more and more of these patients. This would seem like even more reason for the PPACA, right? Nope, and here’s why:
The PPACA also has implications for providers. More stringent guidelines to provide more cost- effective care. Nothing wrong with that. One of the yardsticks with which providers will be measured is their readmission rates. Currently, there are a few diagnoses where hospitals are penalized for excessive readmissions. As a part of the PPACA, four more will be added by 2015. One of these is COPD.
And that is whete the respiratory therapist in me gets all fired up.
COPD. The bain of my existence. My livelihood. But these are the worst patients that CMS can use to penalize hospitals for readmissions. I understand the concept: if we’re doing our job, the patient won’t be readmitted within a certain time frame. The problem is this: while some COPD patients are dream patients, I would say the majority of my patients are non-compliant. They won’t quit smoking while their alveoli fight with each other for every breath. They pick and choose which of their respiratory meds they take and when. (No, inhaled steroids are not going to work if you only take them as needed, and you should not stop taking them just because they don’t work as rescue inhalers.) And toward the end, they could be in and out of the hospital every week. So if hospitals stop getting reimbursed adequately for these admissions, they lose progressively more money as time goes on. That is the same money they use to attract and recruit higher-credentialed staff. The same money they use to provide indigent care. The same money they use to obtain equipment. To maintain equipment.
But my other problem? We all speak of the access to care. Well, if you live in the U.S., you have access to care. If nothing else, you can go to an ER where we have to evaluate you. That is access. What is truly lacking is a way to pay for it.
Is the U.S. healthcare system having trouble? Yep. I don’t blame hospitals or providers. I don’t blame insurance providers. Thete are many pieces of the puzzle, in my humble opinion. Lawsuits. Malpractice insurance. ER abusers ( by this, I mean drug-seekers, etc.). Doctors being forced to practice defensive medicine. (And if you don’t buy that, ask me and I’ll tell you the crackhead story.) Drug patents. And us. Yes, us. We want the latest and best. When a standard x-ray is sufficient, we still want the CT. When a cheap generic drug will work, we want the brand. And doctors are stuck. Patient satisfaction is a reimbursement buzz word, and if they don’t give us what we want, we get upset and don’t stop until we get it. Whatever it is, it may not be the most cost-effective, or even the most effective. We need to leave doctoring to doctors.
So, yes. I am a healthcare professional. I am hopefully a future hospital administrator. And for all of these reasons and more, I am completely against the PPACA. And I will vote accordingly in November.