Do the Right Something

 

Ever since the Affordable Care Act (ACA) went into effect, allowing healthcare access to tens of millions of people who previously had none, we have heard a constant refrain: “We have to do something about Obamacare.”

Key features of the ACA include: Permitting children to stay on their parents’ plan until age 26; requiring insurance companies to cover such women’s health issues as family planning, pregnancies and C-sections; covering mental health; providing basic preventive care; overriding exclusions for pre-existing conditions; and enabling people with part-time jobs who lack insurance to purchase coverage through an exchange.

This additional coverage has come with a cost, hitting affluent citizens the hardest. Premiums have continued to rise exponentially, although less than many predicted prior to implementation of the ACA.

In recent months, I hear the drumbeat grow louder: “We have to do something.”

I agree, but I thought doing something meant doing something to improve the situation, not make it worse.

Doing something should mean lowering drug costs for a child with a peanut allergy whose mom is suddenly told at the pharmacy that a refill for that epipen will be $600 please.

Doing something should mean finding the means to provide more – not less — help for those heroic families caring for, adopting and raising children with complex medical conditions and special needs.

Doing something should mean trying to reduce healthcare premiums for the middle class.

Doing something should mean that after increasing health insurance coverage of children in our state from 88% prior to the ACA to 96% today, we should strive to cover 100% of our children.

Doing something should include paying adequate rates to those in the mental health field who help families with the most challenging, gut-wrenching diagnoses. Suicide is now the number one cause of death in South Carolina among children ages 10-14.

Doing something should not result in the resumption of lifetime caps on payouts for health conditions, so that a premature infant in the neonatal intensive care unit does not use up her entire lifetime allotment during the first week of her existence.

Doing something should not drive rural hospitals and health clinics into bankruptcy so that for many people the nearest hospital will be hours away when it’s time to deliver a baby or when a loved one has a heart attack.

Doing something should mean that physicians have more time to talk to even more parents about the importance of reading with children, how to handle a tantrum, setting limits, instilling healthy eating habits, promoting oral hygiene and discussing the importance of safe sleep routines.

Doing something should not mean that 22 million people lose their health insurance.

“Something” certainly must be done to insure affordable access to healthcare and to reduce the many unseen costs to our society when that access is restricted.

The bill currently before the U.S. Senate is the wrong “something.” It is opposed by the American Academy of Pediatrics, the American Academy of Family Physicians, the American Congress of Obstetrics and Gynecology, the American College of Physicians, the American Osteopathic Association, the American Psychiatric Association, the American Medical Association, the Children’s Hospitals Association, and the March of Dimes.

Please encourage our lawmakers to work together to improve the Affordable Care Act, not destroy it.

Martha Edwards, MD
Immunization Chair and District Representative of the SC Chapter of the American Academy of Pediatrics

 

 

 

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Roman ER on the Itinerary? Fear Not.

this memory from July 2012 popped up on my Facebook feed this morning, and it seemed a good time to share it again. 

Italian kidney stones are less expensive than American ones. This is how I know:

On our second day in Rome, my husband started writhing on the floor of our hotel room in agony. We initially assumed he had strained his back, and I was overwhelmed with guilt since he had carried my bag as well as his (it was small! I swear!). But then we figured out it must be a kidney stone. He has never had a kidney stone. Apparently Italy is as good a place as any to have your first one.

So off I went in search of narcotics in Rome on a hot Sunday morning.

Times like this, it is good to travel with friends. The Schauers whisked our children away to tour every Roman ruin in sight while I repeated the “for better or for worse mantra” over and over in my head.

Here is a little known fact about Roman pharmacies: they are all closed on Sunday morning. At least the ones within a mile of our hotel were. I returned to the hotel room narcotic-less, much to my husband’s dismay. He had now been writhing in pain for about four hours. Agony does not to begin to describe his condition.

When I imagined touring Rome, I imagined touring the Coliseum, the Forum, the Spanish Steps, the Trevi Fountain, the Pantheon, with several stops along the way for cappuccino and a gelato. The Roman Emergency Room was not on my list. But it became clear that would be our next stop.

The taxi dropped us off at the door and zoomed off.

There was no wait. Because everyone in Italy has access to healthcare, no one was there with a cold or a hangnail, waiting for hours to be seen, then sent to collections for a bill they could never begin to pay.

We rang a little bell, and out popped a provider who took a brief history, did a brief physical exam in which Nat ran away from her when she tried to thump on his left flank (inflamed, hydronephrotic kidney located there), then showed me to the waiting room and took him back for further evaluation.

Evaluation included a urinalysis, some blood work, and a renal ultrasound (done by the radiologist himself, not a tech) which confirmed that he did indeed have a kidney stone, and he received IV fluids and toradol resulting in immediate relief. Ninety minutes later, he was dancing down the hall, insisting that we tour the Coliseum, the Forum, the Spanish Steps, the Trevi Fountain, the Pantheon, stopping along the way for a couple of cappuccinos and a gelato.

But our first stop was a little shop down the street so that he could buy his new ER buddies a couple of boxes of chocolate because when he asked about the bill for the excellent care he received, they laughed and said “there is no bill for this!.”

Nat and I fully understand that there are some drawbacks to socialized medicine, but as patient and patient spouse last Sunday, we became fans. As we toured Rome, we did not come across any physicians begging for Euros on street corners and wondering how they were going to feed their family that night. It is true that the Italian economy is not in great shape… but last time I looked, neither is ours, and healthcare bills remain the number one cause of bankruptcy and misery for families in our country.

I have a friend whose daughter recently suffered a complicated course of kidney stones (to be fair, much more complicated than Nat’s). Last I checked, the bill was nearing $100,000. Fortunately, she remains on her mother’s health insurance because of Obamacare. Another friend recently had knee surgery and spent one night at the hospital. She recently received her bill: $70,000.

We liked our bill better.

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