Getting real about fixing health care

A lot of great quotes have been attributed to Winston Churchill, British Prime Minister during the World War II era. Too bad he didn’t actually say some of them.

That’s probably true of one of my favorites, although I’m not going to let that stop me now.

The nonquote I have in mind goes like this: “Americans can always be counted on to do the right thing — after they’ve tried everything else.”

(He really should have said that.)

That line came to mind after the latest health care roller coaster ride that ended with Arizona Sen. John McCain’s movie-moment no vote.

In his statement, McCain had this to say:

“We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve.”

To paraphrase, we’ve already tried everything else. Maybe it’s time to do the right thing, which would consist of keeping what’s working and fixing what isn’t.

Maybe it’s a pipedream in this moment of extremism, but it would be the best solution for the American people.

While I’ve spilt a lot of ink (or pixels) defending parts of the Affordable Care Act, I’ve never been an uncritical supporter. At best, it’s an extremely indirect way of getting part way to where we should be, i.e. covering all Americans. It works really well for millions of people — including around 225,000 in West Virginia — but not much or even not at all for others.

Recently, my co-worker, Lida Shepherd, with help from Andy White, interviewed several people impacted by the ACA who received care from Cabin Creek Health Systems. Some purchased health care on the exchange and some were covered by Medicaid expansion. A former coal miner received additional help for black lung due to ACA amendments pushed through by the late great Sen. Robert C. Byrd, D-W.Va.

Nearly all of those we interviewed had pre-existing conditions, including cancer, diabetes, heart disease, irritable bowel syndrome, thyroid disorders, Hashimoto’s syndrome, sleep apnea, addiction, anemia, arthritis, endometriosis and more

We didn’t talk to enough people to get a scientific sample, but it gave us a pretty good sense of where people were.

Generally, those who received care through Medicaid expansion were very enthusiastic about it. Others, who received care through the exchange, were glad to have coverage, but some were more critical, especially those experiencing rising premiums, co-pays and out-of-pocket expenses.

For those in recovery, addiction treatment through Medicaid expansion was a godsend. One woman put it this way: “I wouldn’t be here without it, that’s for sure. I wouldn’t have a job. I wouldn’t have a home. It’s affected my whole life. Before I came here, I didn’t have a job. Now I’m an assistant manager. I’m healthy. I’m happy. My son has a great life. He’s happy.”

Another woman echoed that sentiment: “You literally wake up one day after you’ve had nine months or more of sobriety and you’re like — OK, I didn’t realize it but my house is clean every day. My daughter always has clean clothes and food. Her hair is always done.”

In some cases, the ACA was a mixed blessing, but still a blessing. The former miner related how he and his wife purchased coverage on the exchange for her, only to find out that she had a potentially fatal heart condition. He said that news “just took the bottom out of my world.”

Thanks to the coverage, she could get lifesaving but expensive surgery. He said, “Obamacare, although I paid a severe co-pay and a severe out-of-pocket pay, which was roughly $15,000 combination of the two, they picked up the rest of the bill. In that perspective, I got a bargain, though it was a large amount of money.”

A woman struggling with several pre-existing conditions and buried in out-of-pocket costs was frustrated with the ACA but said, “You tell me how I’m going to get insurance coverage by anybody else if this does completely go away, because I have pre-existing conditions. I can’t not have health care. I’m terrified. What am I going to do?”

If I had to sum up what everyone had to say in one sentence, it would be something like, “Make it better if you can, but don’t take it away!”

Otherwise, as one gentleman put it, “You might as well dig some graves, ’cause you’re going to be burying them.”

In a less-irrational world, the fits and starts (mostly fits) of repeal would give way to basic problem-solving on issues such as bucking up the individual market. According to the Commonwealth Fund, a private, nonpartisan health foundation, “The immediate concern is stabilizing marketplaces to ensure that the 17 million to 18 million people getting coverage through the individual market will be able to successfully re-enroll during this fall’s open enrollment period.”

Other basic steps would include ensuring that basic plans are offered in areas currently “bare” or without a plan available, and dealing with the issue of reinsurance, which causes problems for patients when one insurance firm acquires another.

West Virginia’s senators, Joe Manchin and Shelley Moore Capito, are uniquely positioned to move the discussion in a more productive direction if they seize the moment.

In any case, I hope all members of Congress and the current administration will consider what one person had to say about it: “Take away your own health care and see how you like it.”

(This appeared as an op-ed of mine in yesterday's Gazette-Mail.)