Monday, January 4, 2016
January 1, 2016
The Human Face of ObamaCare: Promises vs. Reality and What Comes Next
By John Geyman, M.D.
Now that the Affordable Care Act (ACA) has been upheld by the U.S.
Supreme Court as the law of the land, it is the target of an intense
partisan debate during this 2016 election cycle. Confusion,
disinformation, and misleading rhetoric dominate the airwaves as
politicians and their corporate backers offer up wildly different
approaches to our health care problems and solutions.
After six years with the ACA, there is a large base of experience to
draw upon to assess, on the basis of evidence, what has worked and not
worked. So it is time to reassess its impacts on the problems it was
intended to address--reduced access to health care, uncontrolled costs,
increasing unaffordability, and unacceptable quality of care for our
Despite promises of the Obama administration before the law was passed
that we can keep our insurance if we like it, stay with our same
doctors, and save money at the same time, many millions of Americans
have too often found these assurances to be empty. Having insurance
"coverage" for many does not translate into having access to affordable
necessary care. Instead, the largely for-profit "system" continues on,
profiting and sometimes profiteering from expanded markets subsidized by
us, the taxpayers. The original title of the ACA as the Patient
Protection and Affordable Care Act (PPACA) has become a misnomer, not
surprisingly little used today.
Too we are often bombarded by abstract numbers and statistics that
neglect what they mean to ordinary Americans. This book takes a
different approach, starting with stories of patients and their
families, thereby putting a human face on the large body of experience
and evidence about the effects of the ACA since its passage in 2010.
Far from isolated anecdotes, these are common stories that best
illustrate national trends and problems in our increasingly
dysfunctional market-based system.
The book is organized in three parts: Part One presents some 50 patient
and family stories that represent problems confronted by implementation
of the ACA since 2010. These are real people and their families drawn
from press reports. Part Two looks at five major problems of the entire
system, as we consider to what extent the ACA has addressed them, and
find that we are far from the health care reform that we need. Part
Three deals with where we are now, in the middle of an election year,
faced with three main alternatives about where to go next: (1) stick
with the ACA or try to improve it; (2) repeal and replace it with a
Republican "plan"; or (3) move to single-payer system of national health
insurance. You will notice that many of the chapters start with a
heading, "The Promise", "The Premise," or "The Myth." These denote
either the promises made by the Obama administration about the ACA or
the premises underlying it, which typically and ironically are based on
earlier conservative ideas put forward by conservative organizations,
such as the Heritage Foundation.
The stakes are too high to get health care wrong in this country. Our
incremental reform attempts over many years have been compromised by the
money and political power of corporate stakeholders that perpetuate many
of our problems. We need objective evidence to combat the rhetoric and
claims of the medical-industrial complex and direct our attention to the
real needs of patients and their families. It is my hope that this
book will help in this process.
--John Geyman, M.D.
Friday Harbor, WA
Comment by Don McCanne
Although many had high hopes for ObamaCare, as John Geyman shows us the
human faces, we realize that reform fell too short for too many. He
shows us not only those human faces but also the pained face of health
care justice. He provides us with an understanding of what is wrong with
our system, and then describes options for the future. He encourages us
all to participate in the reform dialogue so that we can finally get
this right. The Human Face of ObamaCare is a great place to start.
at 8:09 AM