Wednesday, September 11, 2013


I had one of those What-Do-You-Think-of-This-Gonna-Bankrupt-Us-Obamacare-Crap conversations again this week.  People ask me.  They think 'doctor' is a synonym for 'rich republican' and that all doctors oppose the Affordable Healthcare Act.  I'm here to correct that impression.

First, doctors are just people.  Very busy people.  I'm willing to bet that not one in a thousand of us (including me) have read the entire piece of legislation.  No surprise - I've never read the rules of what Medicare covers, or BlueCross/BlueShield for that matter.  I've never read the fine print of what MY health insurance covers. 

But I think it's a good idea.  Maybe not a GREAT idea, but a very, very good one.  And I really think that we should stop crediting President Obama with this idea.  The Clintons, Hilary in particular, tried to put forward a similar plan in the early 1990's.  And Mitt Romney put an almost identical plan in place in Massachusetts when he was governor there, and that plan seems to be working very well.  Since he was the first to succeed, I feel we should honor him by calling Affordable Healthcare "RomneyCare". 

RomneyCare matters.  Prior to the passage of RomneyCare, here's what our family was facing:

When Babygirl went on dialysis, a medical coverage clock started ticking.  Medicare (for those of you confused about public insurance, we Medi'care' for the elderly and disabled, and Medic'aid' the poor) begins assisting with health care costs for renal failure patients three months after they start dialysis or receive a transplant, whichever comes first.  Medicare is secondary to any private insurance for 30 months, and then becomes the primary insurance provider. Dialysis is covered for its duration after that, so if Babygirl had not received a kidney for 5 years, she'd have remained on Medicare the entire time.  Once a patient receives a transplant, Medicare gives you 30 more months and is done.  Medicare covers 80% of expenses.  Babygirl qualifies for free prescription backup which does NOT cover her transplant meds.  Those could be obtained under the hospital coverage at 80% (our 20% would be well over $1000/month).  Her Medicare costs us $104/month.  A policy to cover the remaining 20% would run about $150/month, but we don't need to do that because we have my work insurance, which costs $120/month plus co-payments and deductables (about $200/month, maybe more - ask me at the end of the year).  Healthcare, therefore, is costing this family of three $574/month with an additional $50/month in prescription costs, and has saved us over $2000 so far in hospital and lab costs.  Call it $180/month, subtract the cost of the premium:  Savings of about $75/month.  If she lands in the hospital again, quadruple that.  These are our pre-RomneyCare costs.

Babygirl is fourteen.  She received her transplant 19 months ago, and therefor has 11 more months of Medicare coverage.  How much it will cost to care for her after that will depend on the number of times she lands in the hospital.  When she turns 18, if she doesn't go to college, she'd be off our plan.  She would qualify for Social Security Income, but it would be based on my earnings.  It will be too much to call her poor, so no Medicaid.  It will be too little for her to afford a full-fledged healthcare plan, so no coverage at all. 

We've talked before about what this means.  No insurance = no medications.  No medications = rejection.  Rejection = dialysis.  Dialysis = Medicare coverage in three months and back on the transplant list to repeat the cycle over and over and over.

The initial phase of RomneyCare has helped with that.  I can keep her on my insurance until she's 26, so I only have to keep working until I'm 68 to keep that going (not my initial retirement plan, but hey, beats watching your kid die).  When the rest of RomneyCare comes into effect, it may allow me to retire at a more reasonable age and still hope that Babygirl will have health insurance.

People are always utterly astonished when I explain the results of repealing RomneyCare.  They are always amazed when I point out that they are already paying (in increased hospital bills) for the uninsured who use the ER for primary care and can't afford to pay. They are stunned when I point out how many community hospitals have been forced to close because they cannot afford those losses.  They are always shocked by the notion that a HUGE percentage of bankruptcies occur because of uncovered medical expenses.

Massachusetts is not bankrupt.  Canada?  Not bankrupt.  Australia?  Not bankrupt.  Costa Rica?  Not bankrupt.  WHY do people assume that WE will bankrupt ourselves by taking care of our poor and lower middle class's health care?  I really do not know. 

As a doctor, will I make less money?  Maybe so.  But I'm already at the bottom of the doctor pay scale because I care for the poor and uninsured.  And I've already learned that I can live on less.  My Christian conscience will not allow "the least of these" to go without at least basic health care! 

I think we all owe Mitt Romney a huge 'thank you' for being brave enough to institute a compassionate system of health care for his constituents in Massachusetts.  The fact that he has become a coward and backed out of thinking that the people outside of Massachusetts deserve the same is sad, but thank God President Obama was willing to cross party lines and borrow the Republican governor's lead with RomneyCare.


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