John Scherr isn't your typical Obamacare volunteer.
Nor is he your typical doctor, medical administrator, small business owner or individual insurance customer. It's his combination of experiences that led the recently retired Charlotte physician to create a blog that delves into the potential and problems of the Affordable Care Act.
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Scherr says he's been interested in ways to rein in health care costs since his days in a private internal medicine practice in Atlanta in the 1980s, when HMOs were the rage. He volunteered to take part in one of the early "capitation" contracts, in which doctors are paid by the patient, rather than collecting a fee for each office visit, procedure and test.
About 20 years ago, he was part owner of a business with about 100 employees. There, he says, he learned the challenges of huge annual premium increases, which often meant switching providers and forcing employees to change doctors.
When he came to Charlotte, he worked as a hospitalist (a doctor who sees patients only while they're in the hospital) for Carolinas HealthCare System and got involved in administration of that group. And when he started thinking about retirement, he got an eye-opening look at what it would cost to buy his own insurance, an experience he writes about in a post titled "Obamacare and Me." This year he helped his two adult daughters buy insurance policies on the federal exchange created by the Affordable Care Act, and that's where he expects to get his own insurance (without subsidy) in 2015.
Scherr recently took the 30-hour training to become an ACA health insurance navigator; he has started volunteering with the nonprofit Enroll America. He's tapping that experience for a series of posts on the twists and turns of our nation's health insurance revolution.
A self-described liberal Democrat, Scherr writes that he was deeply disappointed by the compromise that won Congressional approval, modeled largely on conservative plans. But he says his interest now is on getting past the political rhetoric of the left and right to explore the reality of what's happening and what's to come. He writes that he sometimes feels like a Republican as he learns to value the free-market competition between insurance companies: "This competition will encourage, for the first time, health insurance companies to lower medical costs. If they have lower costs, they will be able to offer lower premiums, and thus receive a higher market share. ... All that’s needed now is to get Amazon involved in the health insurance delivery business, and the problem will be solved entirely."
Scherr says he hopes his blog will help people understand how to get better, less costly health care. He'd also like to encourage policymakers to join him in open-minded exploration.
"Republicans just want to vote to repeal the law, and Democrats don’t want to admit that there is anything in the law that needs to be changed," he writes. "There is more than enough blame to go around, and there are plenty of improvements that need to be made. Hello, Congress? Pay attention to your constituents! Get it together and do your job! Debate, argue, defend, parry – but at the end of the day, COMPROMISE and come up with some solutions that are not so fundamentalist in nature that only the hard-wingers on both sides are heard."
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18 comments:
As someone who works daily with Mediciad - the primary problem is largely relate to fraud, waste, and abuse. Not just by providers, consumer fraud is rampant. As it stands, medicaid is the best insurance in the world. Three dollars buys you open heart surgery or a series of chemo. Not every child who lacks discipline at school needs weekly therapy sessions AND a free cab ride back and forth for mom and the child. Shame on the providers who send every kid to a therapist. Shame alos on the system for giving free braces to every child that wants a perfect smile. No other insurance, gives such orthodontic care, so why does Medicaid? And don't let anyone tell you people in the US that are undocument do not receive Medicaid. ANYONE who wants to have a baby and has no insurance can have Mediciad pay for Labor and Delivery.
There is nothing affordable about Obamacare. A.K.A. affordable care act. I had great insurance before this. I did not have to worry about how much a dr's procedure was going to cost. Yes I paid more for a cadillac plan that covered 100 percent but it well paid for its self in the long run. Now I have 80/20 coverage, 750 dedcutible, my dr copay visits went up and it's financially ruining me. It's a huge hit to my bank account. Yes I pay less per month but in the long run, I am paying a lot more than I ever have for my health. Ya it's great if you do not have any long term illnesses and see the dr once a year for a physical. I'm not 20 years old, I'm almost 50! Living alone and having to make up the cost diffence between before an after is huge! People could get free health care before Obamacare.
Thank you for this post and for the opportunity to learn about Dr. Scherr's blog. His comments regarding reform of the ACA are most appropriate. There are many fixes that will make it much less objectionable to consumers, but the stalemate in Congress stands in the way of those changes. In the past, Congress would meet as legislation was being implemented and would make "technical corrections" to unforeseen complications or complexities when the legislation was originally passed. The value of compromise is so important to legislation because of all the varied interests that contribute to the end result. Writing one rule for all the population may see possible, but we live in an essentially free country where doctors, patients, and facilities are impacted by religion and income and health histories that make the world of health care delivery so expensive and complex. There is no easy solution. We are in this together.
I agree we as a society have the obligation to provide a certain level of care to all citizens, regardless of ability to pay. The issue I have is how to pay for that care. Prior to Obamacare, costs for the uninsured were passed along to other medical consumers. Healthy people got a break. Now, we are heading in a direction to spread those costs over all of society, like a tax. Healthy people pay too. That's a good thing. Obamacare is not the best solution we can come up with, it's just better than what we had before. Obama gets tons of credit for his work getting us here, but lots more work is needed so we keep moving forward and don't slip backward.
Dr. Scherr,
Serious question: How is a country $17,000,000,000,000.00 in debt "wealthy"?
Ditto to Garth's question (above) and I would also like to ask:
What is the difference (from a practical standpoint) between healthcare (not) being a "right" we as Americans are born with....
but it is an "obligation" we must provide to all of our citizens.
That is, I would say, a distinction without a difference.
The world doesn't need another shill for Obamacare. Just look at the Charlotte Observer. They're taking money from an insurance company to fund Ann's salary and keep her writing sunny stories about Obamacare. The insurance companies depend on the good graces of the Obama administration to keep the money rolling in for their substandard Obamacare plans. No wonder the insurance companies have to fund people like Ann to buy some positive press for the administration's unpopular law.
It's shameful that The Observer is a part of this. The Obamacare coverage is becoming a parody on objective journalism.
...such contradictions in this piece....
Not born guaranteed to have healthcare, but we (government) should give everyone healthcare and call it "affordable".
Okay, who pays for it?
From a 60 Minutes Piece on those caught in the middle of Obamacare:
..More than 8 million people have signed up for Obamacare. But many others have been left out. Millions of Americans can't afford the new health insurance exchanges. For the sake of those people, Obamacare told the states to expand Medicaid, the government insurance for the very poor. But 24 states declined. So, in those states, nearly five million people are falling into a gap -- they make too much to qualify as "destitute" for Medicaid, but not enough to buy insurance.
This sums up why we didn't need Obamacare to totally disrupt the system we had.
Upwards of 30 million still without insurance, many who could have afforded some coverage before the ACA now can't but can't get Medicaid because 24 states refused to expand it due to the looming costs three years from now.
Obamacare is a complete disaster. It used to be NEW Coke was the worst marketing disaster in history.
Obamacare surpassed NEW Coke to take the top spot.
It is unfortunate that you extract from a "60 Minutes" piece and then jump to your own conclusion. Yes, there is a gap and that gap can be filled if the states would expand Medicaid the way it had been planned. Those that have withheld that Medicaid expansion happen to be states run by Republican governors who are still fighting the implementation of the Affordable Care Act including Governor McCrory from North Carolina. Had Medicaid been expanded, North Carolina could make even greater strides toward covering the uninsured. The failure you describe is not the fault of the ACA, but the NC legislature for not implementing that expansion. You cannot blame Obama or the federal design when states are not accommodating.
John Paul,
Tel me what these same individuals did about healthcare BEFORE the ACA?
The didn't have insurance and magically lost what they didn't have, right?
Also, the states were correct in turning down expansion due to the fact the cost will escalate out of control going forward and after several years, the Feds cut the reimbursements back to 90%.
If you want to pay for the other 10%, please feel free to send a check to one of the other states who will need that money to makeup the 10%.
By the way. This is the same as the failed stimulus when Obama gave states for education, they spent it, then couldn't fund the loss.
Before the ACA, you had to consider what you were willing to give up when you did not have health care. Many declared bankruptcy, others decided to not have surgery and died rather than bankrupt their families or businesses. Others still had extended payments to hospitals for many months and years. I hope you are never in either of those circumstances to be bankrupted because you do not have health care or even worse pre-ACA...if you collected a certain disease or condition prior to obtaining health care, insurance companies refused to cover individuals under those circumstances. Think about it.
John, Unfortunately you have fallen for one of the myths of
Obamacare. If you are seriously ill who will pay your house payment? Car payment? If you can't work who will pay your insurance premiums. Obamcare does not stop medical bankruptcy.
As a matter of fact, if you purchase care under the Affordable Care Act, you will be much less likely to file bankruptcy as a result of health care costs. First, your out-of-pocket costs..(i.e. deductibles and co-pays) will be limited to the those in the package you choose to purchase. You will also benefit by having coverage that is not limited to a total dollar amount dictated by the insurance company. Should you have an expensive catastrophic disease or condition, you will get the service you need without upward limits on your costs. That will help to immensely reduce the incidence of bankruptcies stemming from health care related expenses. With regard to your final question, if you cannot work,who will pay your health care premiums, the answer lies in a simple visit to the health care exchange online where you adjust your earnings and income and you are given a revised plan that will be subsidized to the degree that you need that support. The ACA vastly improves life with regard to health care. There are still many ways that it can be improved and the complexities fixed, but that requires bipartisan efforts that are not in the cards today.
"The ACA vastly improves life with regard to health care." that's just another myth. It does for some but most are losers under Obamacare. Here is my personal experience. I was paying $174 a month for a high quality BCBS policy with no lifetime limits. Not a sub par policy which is another Democrat myth. My policy was cancelled on a lie, with 5 million other people who buy their own insurance. The new policy is $450 per month with a $5500 deductible. That's almost $11,000 per year or $44 per work day before insurance kicks in. This is not affordable by any means. It is not even insurance it is a thinly veiled wealth redistribution program. I did not need or want any help from know it alls like yourself. Before you make some assumption look it up yourself at www.bcbsnc.com. I am a 54 year old male who makes too much for a subsidy. Just wait until the delayed employer mandate kicks in & those people get cancelled and/or huge rate increase like me.
It is hard to compare apples with oranges in the description you raise. We have no idea what $174 a month premium covers and what the deductibles and co-pays were in that policy. Generally, less expensive policies had higher deductibles or dramatically fewer benefits or coverage. I do not understand why you would encumber the $5500 deductible if you are healthy. There is no need to include that in your annual cost unless or until your benefits have exceed your coverage provisions to that degree. The ACA does a better job of ensuring that all people contribute to the cost of care by requiring participation in standard plans that are available to all. Usually lower premiums were the result of higher deductibles and co-pays and that coverage only went to healthy people. If you happen to be quite sick or diseased, you had no access to coverage or care from any insurance company. Don't be driven by knee-jerk reactions. Be happy you make too much for a subsidy. You are fortunate. A standard package of benefits and deductibles will provide more care to more people without leaving people out of the system.
Ann Doss Helms has appropriately reflected what I am writing about in my blog, but there is one caveat. I am not writing a blog about Obamacare; I am writing a blog about my thirty years in medicine and how that experience has helped shape the thoughts and feelings I have about many of today’s issues, Obamacare being one of them.
I’ll respond to several comments here. I like to see good discussion built around differing opinions since that is what the blog concept is all about.
To Adolf: I agree that Obamacare, as it is written, has a long way to go to become the best solution, but it is the best start we have had in reducing the number of uninsured since Medicaid was created in 1965. That is a long time to have made so little progress with this big problem. It is a start, and the hard work to improve it should have started several years ago.
To Garth: Our national debt and continued deficit are big problems, no question, but debt and wealth are not mutually exclusive. The United States has one of the highest per capita GDPs in the world, and it is the ONLY country in the top 20 that does not have universal health care. I do understand frustration with how much money insurance costs and it should be a national goal to reduce healthcare costs to a much lower percentage of our GDP. Societies have to make priorities as to where it allocates its financial resources. To me, healthcare should be a high priority.
To Anonymous: There is a difference between healthcare being a right and my belief that we have an obligation to provide healthcare but, you’re right, both of these result in people getting healthcare coverage. I understand the distinction between people saying they “deserve” healthcare and others have to provide it to you, and the notion that, as a society, we have an obligation to not let our people die in the streets because they don’t have the money to be seen by a physician. I believe it is not a distinction without a difference.
To Wiley: An integral piece of the plan to reduce the number of uninsured under Obamacare was the Medicaid expansion. However, the Supreme Court ruled that this vital part of the legislation would henceforth be optional, so each state could either accept the Medicaid expansion or reject it. Of course, the divisions between those states that accepted and those states that rejected were as Blue and as Red as could be. A functional government would have figured out how to deal with this resultant giant black hole in coverage, but we don't have a functional government. The original design of the ACA took care of these people; it was not a flaw in the law. It is a function of poor government.
To Thomas: Obamacare – or any medical insurance at all – could never be a financial savior for a person with a catastrophic medical condition or who becomes disabled. But for someone who requires a 7-day hospitalization or needs their appendix removed, the ACA absolutely can save that person from financial ruin. No one should have to choose between buying their medications or securing food and shelter. I can’t dispute your own personal insurance example, but this certainly must be an extreme, as it does not reflect my experience at all. I really am an ACA Navigator, and I really do have a lot of experience with insurance policies. Pre-ACA, I looked at insurance premiums for high quality BCBS policies and found none anywhere close to costing only $174/month. There were some policies available with those premiums that did not cover many of the medical necessities that a 54-year-old should be accessing and that carried a deductible of $10,000.
Honest discussion between people who disagree is a fundamental American principle. Honest discussion between opposition parties in our government – and compromise -- is what has made our democracy work.
Very thoughtful comments, Dr. Scherr. Thank you.
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