New Year 2021

‘We do not learn from experience… we learn from reflecting on experience.’

John Dewey

Before we finally close the door on 2020, we should take a moment to reflect on the year.

We need to remember all those we lost this past year. Whether from COVID, or cancer, or heart disease, or stroke, or violence, or other diseases and natural causes, we have lost far too many people.

We need to remember all we have learned in 2020. 

We always knew that our first responders and health professionals were essential, we now know that delivery drivers, pharmacists, grocery store workers, janitors, truckers, and so many others are the ones who kept us healthy, clothed, fed, and secure.

We learned that teachers are even more remarkable than we ever gave them credit for.  They pivoted on a dime from in school to virtual learning to hybrid and every combination thereof.  They created new lessons, found new ways to engage and interact, and keep children curious and educated.

We managed to live without sports and entertainment and found new ways to connect with family, friends, nature, and our communities.

We saw a successful return to space through private company launching from American soil.

We managed to safely and successfully fast-track a vaccine to change the course of this pandemic and bring a sense of normalcy back to our chaotic world.

There have been other medical advances that have improved the lives of patients around the country and around the world.  We must continue to invest in research to ensure this momentum continues.

As we welcome in 2021, I remain hopeful and optimistic that we can take these tough learned lessons and create a better tomorrow.

That we learn to be respectful and civil to our neighbors and fellow countrymen.  We do not have to agree with each other, but we do have to live together.  Our differences should not divide us, but provide opportunities to collaborate and to improve.  We all want a better world for our children and for each other. Kindness does not take an additional effort but makes a huge difference in how we interact.

We need to continue to remain engaged in politics and policy, to stand up for what we believe in, and to vote those beliefs.  Individualism remains much more important than party loyalty.  We need to continue to improve the processes to make it easier and more secure for everyone to cast their ballot.  Government works best when ALL voices are heard.

We have learned how important our health is and access to care.  It is time we put aside the politics and find a way to ensure everyone has consistent access to quality, affordable care.  No one should have to choose between medicine and food, or choosing between losing their home or losing their child. 

We must continue to fight for equity and equality across the country.  Our ‘freedoms’ are meaningless if they’re not applied equally.  As good citizens, we have a responsibility to ourselves and our country to do better.

Finally, we must prioritize education and ensure that truth and facts are the basis of our national discourse.  We need to encourage investment in science and technology, not just to improve medical outcomes, but to ensure our assets are protected in ever-increasingly connected digital world. 

If we can launch a rocket to space, we should be able to do so many simpler, yet important, things.  We just have to put our collective minds and efforts behind it.

Thank you for the friendship, the debate, the support, and the commentary.  Whether we agree or not, my life is richer for each and every one of you.

My wish, as always, is for a healthy and happy New Year to you and your families.

Thoughts on the American Health Care Act

It is time for a paradigm change in healthcare. Access to insurance is not care. Tax credits to offset insurance costs are not care. Until we can make care affordable and accessible, too many people will continue to suffer unnecessarily, and health equity remains a dream.
We must develop a comprehensive strategy to address the needs of all citizens, regardless of income, employment, education, or current health status.

First off, let me state that I think the Affordable Care Act was a good start, but needs vast improvement to ensure healthcare is both affordable and accessible for all citizens.
The Republicans are in an incredibly powerful position today.  They control both houses of Congress, the White House, and a majority of Statehouses around the Country.  This presents them with a unique opportunity to truly change healthcare in America for the better.  Unfortunately, where they appear to have no power is against the insurance industry.
If ‘Obamacare’ was a gift to insurance (and it was), the GOP version introduced in the House yesterday wrapped that up, added some cash, and put a bow on it.  The insurance industry must be thrilled.
Nowhere in the new legislation do healthcare providers benefit. Worse than that, there is no great benefit to people and patients.  For those of us who can afford insurance, and are part of an employee sponsored plan, not much changes.  Rates and deductibles will continue to rise, while benefits continue to decrease.
For those who couldn’t afford healthcare before, it probably won’t become any more affordable.  While there might be some new ‘bargain’ plans, it remains to be seen what that coverage would look like, and what providers would actually accept it.  There is nothing in the proposed law that guarantees lower premiums, puts a limit on annual premium increases, ensures acceptance of your coverage, or anything beneficial to people and patients (that we don’t already have today).  Participants may qualify for a tax credit, but you must pay the premiums first.  For those who cannot afford the premiums, there is no longer a tax penalty for not having insurance.
While many did not like the ‘mandate’ that required insurance coverage, the ‘penalty’ was less than $700 for an individual.  In the new bill, if you have a gap in coverage, insurance companies can penalize you up to 30%.  On a $4000 annual policy, this is $1200.  That money doesn’t go back to the government to offset costs, by the way, it goes straight to the insurers.
The States themselves will be hurt by this legislation, as well.  Today, as always, the burden of caring for the uninsured falls on State and Local programs.  Previously, those costs were reimbursed by the Federal government.  The idea behind the ACA was that with insurance, these reimbursements should be minimalized, if not nearly eliminated.
Under the new plan, those reimbursements are capped.  The States will now have to contend with more uninsured citizens and less money to care for them with.
I’m not sure how any of this can be considered ‘better’, unless you want to only reduce the upfront costs of the program; in that case, great job.  The reality, however, is that the long-term costs will be significantly greater, and the impact on the economy can be devastating.  Rather than doing something to truly change how we provide care to our Citizens, this bill has just limited who gets access to existing care.  Those who struggled to pay premiums may no longer be able to afford the coverages they so desperately need.
If we continue along the path we’ve been following, the sick will get sicker, insurance becomes less affordable, care is restricted, and we all will feel the impact. The staggering costs of healthcare remain the number one underlying cause of bankruptcy. Families should never have to chose between food and healthcare, between heat and healthcare,  or anything else and the care we all eventually need.  This should not be acceptable anywhere, let alone in the United States in 2017.
It is time for a paradigm change in healthcare.  Access to insurance is not care.  Tax credits to offset insurance costs are not care. Until we can make care affordable and accessible, too many people will continue to suffer unnecessarily, and health equity remains a dream.
We must develop a comprehensive strategy to address the needs of all citizens, regardless of income, employment, education, or current health status.