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 V.18 No.48 | November 26 - December 2, 2009 

Miss Diagnosis

Health Reform: Act STAT or Die

Before we begin, allow me to introduce myself: I'm a registered nurse and a family nurse practitioner graduate student. My background includes newborn, maternal and general medical-surgical nursing. You can bet that my column will be liberally peppered with many big words and things that sound like facts. Medicine is super cool, and nurses learn how to be fierce patient advocates, which is why I'm passionate about both disciplines. I believe health care should focus on prevention and wellness. I love babies, old people and hot doctors. Reading my column may unclog your arteries and make you more fabulous.

In some ways, the American health care system is not all that different from you or me. In order to survive, the various organs of the industry must communicate and cooperate with one another and with the outside environment. This is a complex undertaking, and, like a living organism, industries tend to generate their own wastes and toxins.

We humans come equipped with kidneys and bladders, rectums and sweat glands, and a whole constellation of mechanisms for eliminating hazardous materials, but the health care industry seems deficient in this respect. Without the ability to self-regulate, huge sectors of the industry have become diseased. The system gobbles money without restraint. Demand has overwhelmed the primary care and nursing limbs, while lawsuits and third-party payer bureaucracy choke the system’s lifeline.

Waiting rooms are clogged with frustrated patients. Millions of patients aren’t even lucky enough to reach a waiting room. So many of us entrusted with the health of the industry have decided it’s high time we put the sucker on dialysis, flush the system with a few industrial enemas and give it a damn bed bath, already.

I love babies, old people and hot doctors.

Enter the Patient Protection and Affordable Care Act, the Senate health reform bill unveiled Wednesday, Nov. 18. It’s a big, fat legislative piñata stuffed with interventions, all with the stated aim of improving health care access and decreasing costs. The Senate bill, like the beefier HR 3962 bill that has already cleared the House, includes an individual mandate requiring everyone to purchase insurance and penalties for those who do not.

Both bills offer a public option for purchasing insurance from the government, though the Senate bill will allow individual states to opt out. Both bills regulate the insurance industry by disallowing denial of coverage based on pre-existing conditions, and both bills expand Medicaid and create a federal insurance exchange with subsidies for people and families below certain income thresholds.

Of particular note for New Mexico, the Senate bill blocks illegal immigrants from participating in the insurance exchange. Because obviously it’s a great idea and more cost effective to have illegal immigrants crammed into our only Level 1 Trauma center in the state—the UNMH Emergency Department—for primary care rather than allowing them to purchase insurance.

Speaking of costs, the House bill plans to help pay for itself via additional payroll taxes on the wealthy, while the Senate bill will collect money by taxing the most expensive health plans. The House bill will cover 37 million of the 45 million uninsured, while the Senate bill covers 31 million. The House bill costs $1.2 trillion over a decade as opposed to the Senate bill’s $849 billion.

I’m already thinking about the unbelievable satirical value of Obama vetoing his top domestic priority. You got PUNKED, America!

The Congressional Budget Office predicts the Senate bill will lower the deficit by $127 billion over the next decade blah blah snore nap time! If you aren’t comatose already, you’re almost better off reading about the details and differences on the Interwebs, because, as Slate writer Timothy Noah points out, health care reform is something that’s constantly evolving in real time online, with newspapers scrambling to play catch-up. As we speak, the Senate bill is poised to undergo exhausting rounds of debate and amendment before the Senate can vote on it.

And if our protagonist makes the cut, it will be blended with HR 3962 and go back to both the House and Senate for final approval before reaching the president’s desk. I’m already thinking about the unbelievable satirical value of Obama vetoing his top domestic priority. You got PUNKED, America!

Ideally, policy, like medicine, should be based on evidence. But when evidence is lacking, consensus, conjecture and sentiment, and “expert opinion” quickly infiltrate the decision-making process. But unfortunately, it’s just not enough to say you support health reform because everyone deserves health care (which I very much believe) or you don’t support the bill because you oppose government takeover of health care. Since people are suffering and dying, the stakes are extremely high. And there are more than 2,000 pages’ worth of details relating to financing and implementation, regulation and enforcement, restrictions, and concessions to consider.

Kids on the valuable public insurance program CHIP will eventually be moved over to the new insurance exchange, a policy change with uncertain outcomes. Billions of dollars will be cut from Medicare. Abortion rights, which already stand on vulnerable ground, are undermined by the language of the bills. (Much has already been made of the Stupak amendment to the House bill, which prohibits recipients of federal subsidies from purchasing plans that cover abortion services.)

And yet many people believe the bills are a necessary first step towards fixing a system that is already in critical condition, that we’ll get millions of newly insured Americans and a stronger system in return. Act STAT or die. The leadership of the Democratic party and Obama’s presidency may be on the line. It’s politics as usual.

Because of the complexity of the decision-making process involved (definitely a level 5 for all you medical coding geeks out there ... holla!), most people will turn to opinions of the individuals or entities that they trust, such as the American Nurses Association or the American Medical Association (both of which support health reform). As a nurse and future provider, all I can really offer you is a shot of my own cognitive dissonance, and perhaps a bedpan to catch all the messy political runoff in the coming weeks.

Despite its brilliant name, this column is not intended to prevent, diagnose or treat herpes. Or any other diseases, for that matter.

 
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