The Affordable Care Act – On Line Now !

Gentle Reader –

Perhaps like a few of you, I have been watching with growing unease the Government shutdown brought on by the Right’s intense dislike – or so it appears to me – of our Centrist President Obama.  Driving back to glorious Pennsylvania from Florida several days ago, I had the opportunity to listen to an NPR discussion of the shut down.  One of the people who called in – a woman from Minnesota – informed all listening that it was a GOOD thing the national government was shut down.  Because, she went on to say, this was all the result of Obamacare with its death panels and the ruining of the American health care system.

Oddly, even though the NPR host had Thomas Friedman as his guest, neither of them bothered to correct the woman caller.  So my blood pressure spiked to 500 over 300 and I shook my head.  Such idiocy left uncorrected is dangerous.

This morning I went online to, the US government site to begin the application process for obtaining health care insurance.  While I was able to get the the home page, trying to navigate through the site to actually find health insurance products for my State proved fruitless, as the site seemed to be oversubscribed.

So I called the phone number they listed for “more information” (1.800.318.2596), waiting about 10 minutes for a representative to free up.  After the requisite wait, a Ms. Gloria Taylor came on.  If all of the Representatives are like her, we are in for a wonderful time with health care reform.  This woman was kind, patient, and very helpful.  Of course, I didn’t really need to talk to anyone; I am insured through my place of work.  But I wanted to see how the new system worked.

The results, so far:

1. The web site is not as robust as it needs to be and appears to be oversubscribed;
2. The Representative I spoke with was wonderfully helpful.

And what about the Affordable Care Act itself ?  Well, despite the efforts of the Right to obstruct this program – as they had tried with Medicare in the past – it appears to be progressing along rather well.  The cost for the insurance keeps dropping – so far 16% lower than expected by the Congressional Budget Office – and people who are without insurance, remember that most of these are either full time or part time employed, will now have something.

Is the Affordable Care Act the “best of all plans” ?  No, absolutely not.  For my money, a single payor option – Medicare for All – would have been better; but this was apparently not “possible”.  And whatever the plan, all of us will have difficulties and struggles: What will be and what won’t be covered ? Who will decide ? What will the appeal process be ? How will the funding mechanism be organized ?  Using a Medicare formula is not too bad, but the Medicaid formulation is a real problem, as the reimbursement is poor.  How will new technology be incorporated into practice ?  Will there be something like the British National Institute for Clinical Effectiveness ( now called the National Institute for Health and Care Excellence) ?  How will we deal with futile care ?  How will we deal with malpractice ?

This law – the Affordable Care Act – is but a first step in a journey of many miles.  I suspect there will be mis-steps and mistakes along the way.  But the central issue – the provision of health care to the 50 million Americans who are without – is of great importance.

And this is why the Right opposes the law.  This is not about death panels or a government takeover of health care.  It is about taking care of roughly one-sixth of our people: workers, business owners.  Our people.  This law is, believe it or not, a game changer.

About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He served as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders) through 2018 and is presently an intensivist in Florida, struggling through the SARS-CoV-2 crisis. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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