I Can’t Afford It: The Inevitable Rant About PPACA from the Inside

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.


6 thoughts on “I Can’t Afford It: The Inevitable Rant About PPACA from the Inside

  1. With all due respect for your position as a health care professional, and with the admission that I’m not super familiar with the COPD part of the bill (I’ll look it up after I write this, though), I have to take issue with your claim that you can’t afford to pay for care for those who “won’t” better themselves–you are ALREADY paying for their care, in more ways than one.

    First of all, if the only people who buy insurance are people who are likely to use it (parents, the elderly, women likely to get pregnant, people who are sick), then the insurance itself is going to be far more expensive than if everyone, those likely to use it and those less likely to use it, is chipping in. Hence, the individual mandate.

    Secondly, if people who have no insurance use the ER as their back-up healthcare plan, then we all pay for that with our tax dollars. AND it means that the care itself is more expensive than it needs to be because it is emergent care and not preventative.

    Finally, I am on Medicaid. So is my daughter. It is by NO means lesser quality than the insurance I had when I was working full-time and paying for horrible insurance that had lifetime caps and all the rest of it. In fact, I believe that everyone, not just the temporarily-very-broke, should have access to the care I currently have access to. Which is to say, everything.

    I know that the hospitals are hurting. But isn’t that BECAUSE the insurance companies are taking their cut, while nickel-and-diming the actual health care workers and hospitals that provide the care? Isn’t it because hospitals are forced to care for people who can’t pay their bills?

    If I’ve gotten any of this wrong, I’m very open to re-education. But I believe that what you’re paying for your insurance is more than you should be paying–and that, if everyone were chipping in, we’d all be paying less.

    • Yes, Alexa, I am already paying. You’re right about that. The main difference for me is that I am currently paying when I get medical care through the disbursement of the cost for the under-insured or uninsured. And I am paying out the nose in taxes. I am simply stating that I cannot afford to pay more. More in insurance premiums, more in taxes, more in copays that all of the experts are saying I will be paying.

      I am glad that your Medicaid gives you comprehensive coverage. Once upon a time, my family got it also. I would always find that this prescription or that service wasn’t covered. And The problems with Medicare coverage are infamous at this point.

      I agree that seeking emergency care is not the most cost effective for anyone involved, but people do it. Since the passing of EMTALA, the use of ER services has sky-rocketed. My main point there is that we ALL have access to physicians, even if the system is broken. It is the payor system that is in question.

      And finally, the PPACA has huge implications for hospitals. That is my main concern. All of the coverage in the world will not help if there is nobody to provide the services. In all that I have seen about this plan, none of the news articles address this. I had to read the actual bill to find it. This disheartens me. What is good for hospitals is good for all of us. They should not be included with the money mongers, and that is what is happening. People behind a desk are making decisions while people like me are seeing what really goes on, and my fear is that this will eventually come back to hurt us all. COPD is just an example that I can easily use because it is what I do. Incidentally, my mother died of COPD, so I hope noone thinks I am bashing these patients!

      In closing, thanks for your response. I hope you won’t be upset with me if we agree to disagree. There is a method to my madness.

      • Thanks for the long reply! I suspect that we will always disagree with how the issues should be fixed, but at the end of the day, I think the situation is so complicated that more conversations can only help.

        After I posted my comment, I wondered if I’d worded it in an appropriately respectful/civil way, so I appreciate that you gave me the benefit of the doubt if I creeped across the line on what is, after all, your blog. 🙂 I still think that the individual mandate will ultimately make it cheaper for everyone, but that said I’m certainly open to learning more, and I don’t think the bill is perfect.

        At any rate, I’ve been reading your blog and enjoying it, so I’m glad we can agree to disagree, and thanks for replying to my intrusion!

      • No healthy debate is an intrusion! You are welcome to disagree with me openly anytime. My opinion may not change, but if I have that strong of an opinion on something, I usually have my reasons and will explain. And thanks for reading and responding!

  2. I agree with you 100%. Alexa & I are not on the same page, but then again, we rarely are, but remain blog friends regardless. She is definately one who respectfully agrees to disagree.

    While I do not care for the current solution. . . I know that we NEED a better solution.

    As for the COPD patients who won’t stop smoking . . .I’m thinking they CAN’T stop smoking. But Judgy McJudgergovernment treats smokers (and fat people) like weak willed, weak minded losers who are willingly running towards their demise. ON PURPOSE.

    And you KNOW how I feel about that.

    • Yes I do indeed. You’re right. They probably cannot quit. But this new plan makes it sound like, if I am doing my job, I can just tell them to, and it will all be ok. No readmissions, etc. THEY KNOW. I can remind them, but there is no greater deterrent than having two functioning alveoli and being short of breath all of the time. Government just does not get it. Honestly? The solutions that are really going to work to fix healthcare are going to have to come from within. From people who know patient care and see these patients daily. It isn’t going to be a politician.

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