Healthcare Reform: Whatever Happened to Access to Affordable, Quality Care?

Beth McNamara Health Guide
  • As the rhetorical debate heats up on healthcare, much of it centers on the cost of reform and its impact on our ever-growing deficit. A few months ago, at the heart of the reform movement (as I understood the Obama Administration), was the idea that every American would have access to affordable, quality healthcare, which, to some people, is a right not just a privilege. In essence, such reform would change the healthcare delivery model, ideally bringing care, including preventative and chronic condition management care for such diseases as diabetes, to all Americans.

    According to an interview on American Public Radio's July 28 Marketplace with George Halvorson, CEO of Kaiser Permanente, the healthcare reform movement has shifted focus to cost containment and away from Obama's original goals of Americans having affordable access to quality care. Halverson noted that if everyone has access to quality care to support preventive measures, it could save the country substantial costs later on. Halvorson explained that only 8% of diabetics currently get all of the care that they need (note that the radio piece did not differentiate between Type 1 and Type 2 diabetics).  Halvorson went on to say that if the U.S. could get 80% of our diabetic citizens the proper care that they needed now, when they need it, the rate of kidney failure would be cut in half later, thus reducing the costs of caring for those with renal failure.  

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    Yet it seems that, with every passing day, we migrate away from those core goals of affordability, accessibility, and quality in favor of only cost. Not that cost doesn't matter; with a national debt reaching a dizzying amount of $11.7 trillion, it must be a consideration.

    The system as it stands today is not affordable, with one in seven Americans without health insurance, and an estimated 2.4 Americans having lost health insurance since the recession began. Furthermore, third-party insurers increasingly deny more and more claims, even for those that pay them hundreds a month to be "insured" and have costs covered. It's taken me months to try to get approximately two thousand dollars of allowable costs reimbursed for my son's diabetes care, from payments for out-of-network practitioners to prescription reimbursements, and I'm not even 50% of the way there, having spent hours photocopying, sending, faxing, or on the phone making inquiries about the status of my reimbursement. If I "billed" the insurance company the time I'd spent trying to figure out my reimbursement, I'd be ready to retire.

    I admit, I wearied of the inconvenience and inaccessibility of American healthcare long before our family began our diabetes adventure. I stepped "off the grid" several years ago and found a family doctor who provides accessible primary care affordably. The catch: I need to pay out of pocket. The practice, DocTalker Family Medicine, takes no insurance. It was an easy decision to make for me: the practice offers its patients 24/7 access to their medical team for anything from phone-in questions to urgent-care office visits to a house call, therefore paying for the convenience and subsequent doctor-patient relationship was an easy choice for me. The office bases its fees on the time a patient spends with a practitioner, with 10 minutes costing roughly $45.

  • It is this same team of doctors that helped me and my husband during the time that we made our son's diabetes diagnosis. Our family had been visiting New York City right after the Christmas holiday and my husband and I were concerned about the possibility of our son displaying come of the classic symptoms of Type 1. I contacted our doctor, Alan Dappen, via email Sunday morning. Not more than two hours later, Dr. Dappen called my cell phone while I was walking the streets of Manhattan (looking for a snack yet again for my famished child). He wanted to discuss my son's symptoms, gauge the situation's urgency and determine the plan of action.  My cost for the phone call? $45. I frankly would have paid a lot more for the medical guidance offered so quickly and during off-hours.  (In the interest of full disclosure, I joined the practice's team about a year ago.)

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    There is no doubt that cost should be carefully considered as we as a Nation seek to reform our very broken healthcare system. But shouldn't we also return to some of the core objectives that are should be sought with this reform, namely affordability, accessibility and quality?

    Of course, if we look hard enough, maybe some of us can find that affordable, accessible and quality care solutions already exist out there, if only we are willing to pay a fair and honest price to our doctors rather than the hidden costs of a broken health care insurance system which has more interest in today's bottom line than our long-term health.

Published On: July 30, 2009