Health reform: imperfect, but it beats the alternative
Just before the primaries, I met a woman who didn't have health insurance. She was not my patient, but was one of those truly Good Samaritans we hear about. She was driving a patient of mine to my office. She was afraid of the Affordable Care Act because it mandated health care coverage. I didn't understand."Don't you want health care?" I asked."I can't afford it!" she replied.She explained that she heard that under "Obamacare" the government would fine her if she didn't buy health insurance by 2014. She couldn't afford the fine. She couldn't even pay $50 a month for health care. Like many, she was living from paycheck to paycheck. Yet she was willing to drive a friend over 30 miles away to a doctor's appointment."God is my health insurance," she explained. "I pray that I won't get sick."Here in New Hampshire, one out of every 10 citizens has only God for health insurance. As a physician, I have great appreciation for the powers of the Almighty, but even the most faithful could use a little extra help from us mere mortal doctors and the feeble might of the health care community.If this Good Samaritan were to come down with a major illness -- a bad auto accident or cancer, it is likely that she and her husband would go bankrupt in an effort to pay for her treatment.There were 1.5 million bankruptcies in the United States in 2010, and over half of those were associated with a serious health condition. The cost of medications, hospital stays, doctors' fees and health insurance continues to rise at a rate far above inflation.When you consider the multimillion-dollar salaries and compensation packages for the top executives of those same insurance, pharmaceutical and pharmacy companies, it becomes clear that our medical care system is dysfunctional.In 1918, Republican Sen. Hiram Johnson of California coined the phrase, "The first casualty when war comes is truth." This expression seems particularly apt when it comes to the Affordable Health Care Act. The truth about this legislation has suffered casualties from both sides of the political aisle.The health insurers have fought back with a media campaign of their own claiming everything from loss of personal physicians and loss of jobs to a massive increase in the national deficit. Scaring people with misstatements and exaggerations seems to be the strategy for rallying public opinion against it.For the record, written into the Affordable Care Act is an exemption from the fine for people at or below the poverty level.There are some solutions for people like the Good Samaritan I met in my office. There are nonprofit, federally funded clinics as well as volunteer organizations to assist individuals and families who have no health insurance. However, the resources of these organizations are stretched to the max, and their combined efforts are still not enough to meet all the medical needs in the community.More work, more volunteers and more donations are still needed as more and more people lose their health benefits or are unable to afford the soaring costs of health insurance.There are many folks, such as the Republican candidates running for president, who want to get rid of the Affordable Health Care Act altogether. It is by most measures an imperfect solution to an incredibly complex problem. But then what?We can't afford to stay on this path. We can't afford to replace "Obamacare" with no care. Unfortunately, the free market system of health care got us into this mess; it's not going to get us out of it.Unless we come together to address the inequalities of our health care system, we're all going to be saying "God is my health insurance."Dr. James Fieseher of Portsmouth is vice president of the New Hampshire Academy of Family Physicians.