28 July 2017
In the wee hours of the morning, Senator John McCain cast the deciding vote to kill the ‘Skinny Repeal’ bill that Majority Leader, McConnel had finally made public in the middle of the night. This bookended his vote earlier in the week to support the vote to initiate the debate on the repeal and replace bill. He will be off now to seek treatment for the Glioma brain cancer discovered recently.
I am among those nerdy types in Washington that watch the process and who read bills. Not just the words of a bill, I put those edits into the law to see what the words of a bill actually change. I also am one of those that appreciates protocol and process. Like many Americans, I have been frustrated with the entire process this year because the GOP leadership seemed to be doing so many of the things the DNC leadership on the Hill did seven years ago during the development of the Patient Protection and Affordable Care Act (the actual name of the law commonly referred to as ObamaCare). A lack of transparency, putting a bill up for a vote without members or the public having a chance to read it. There were also no hearings in the House or Senate in this session of Congress to review the issues.
Seven years ago America was told this health insurance reform was needed to help people get insurance and access health care. It was obvious seven years ago that the bill that became law that it was based on false promises and that it would not be sustainable. As someone who has seen her health insurance premiums double in two years with less coverage, I know first hand that the changes to the law are driving the cost up to where most of us next year will not be able to afford insurance.
Fixing health insurance is important, but the most compassionate piece is the discussion got lost then and has not been addressed this year either. That piece is the ability for all Americans to access care when needed. This is not just about Medicaid, but about the working poor who may have insurance but cannot afford to seek medical care because of co-pays and high deductibles. Places like Minute Clinics and Urgent Care walk in clinics have taken some of the burdens off Emergency Rooms, but community-based health solutions are what our nation urgently needs.
County public health clinics could serve this purpose, but they are typically focused on immunization services and other government programs. There is a federal program managed by the Bureau of Primary Health Care at the Department of Health and Human Services that suppports this concept, but it is typically underfunded and poorly promoted in the local community.
Whether a community clinic receives federal funding or not, I believe they should offer a fully integrated approach to care, focusing on promoting wellness through lifestyle education programs, access to alternative therapies including chiropractic and acupuncture. Too often clinics turn into prescription writing factories. Science supports the use of non-Rx solutions, but too often, including in the latest health insurance reform debate, these options do not get introduced. There are lower cost, safer, and effective solutions that everyone should be able to access.
As for health insurance reform, in my opinion, I would much prefer having the option to put my pre-tax health dollars into a Health Savings Account (HSA) and use that to buy catastrophic care insurance and visit the health professionals of my own choosing and to purchase the health products of my own choosing. That way, my annual trip to the Nurse Practitioner is covered, my dental, vision and chiropractic trips can be paid for through the HSA, as can any acupuncture visits, dietary supplements, over the counter medical supplies as well as prescriptions.
I have said many times over the last decade that we as a nation are not having the real conversation that needs having. Using the Constitution as the framing document, what are the roles of the federal, state and local government in health care and health insurance regulation? What are the roles of the local community, philanthropy, families, and individuals in providing solutions for accessing and paying for health care? Who should be paying? Too often in the last decade or so, it seems many hand over all the responsibility (and power) to the federal government. The regulation of the practice of medicine as well as health insurance regulations has always been mostly managed by the states until Obamacare.
At the end of the day, the GOP has all the power right now and are squandering it. Eight months into this Congressional session and the promise to repeal and replace has failed. What will they do now? It is time for true leadership to rise to the surface. During the Senate debate, I saw some real progress in what Sen. Bill Cassidy (a physician) and Sen. Lindsay Graham put forward on Medicaid.
We are an innovative and compassionate nation. I have every confidence that by working together we can find solutions. Maybe now, with this new development, legislators will be open to scrapping the failed approaches and looking for effective solutions.