Ricky's Riffs:

Random thoughts on Travel, Education, Health, and the World in General

Obamacare and the Future of Health (in America): Re-Visioning Health and Healing, Part Three

The Supreme Court’s decision to uphold the Affordable Care Act (ACA) has profound implications for the future of American health care. Of course it will lead to changes in how care is delivered. But it will also lead to a transformation in our perception of the meaning of health and healing.

During the past 30 years there has been a steady shift from high quality insurance plans (with low deductibles, small co-pays, and broad coverage) to a managed care model of HMO’s with more limited coverage, culminating in the current crop of super high ($3,000-$5000) deductible policies. Consumer premiums have far outpaced the rate of inflation.  At the same time, payments to providers have been reduced, while insurance company profits have soared.  Meanwhile, millions remain without health insurance of any kind.

Yet pundits and politicians on the right keep pushing to maintain this status quo. They act as if Obama’s legislation is the latest edition of The Communist Manifesto.

The most controversial part of the ACA is the “individual mandate,” which requires everyone to purchase health insurance. This requirement will help fund new health care programs by distributing the costs throughout society. For many, this mandate strikes at the heart of the American ideal of individual choice—of even freedom itself.  Yet at the same time, the mandate resonates with the very Christian notion of caring for those less fortunate than ourselves.

This has created a quandary for the far right. While Fox News characterizes Obama as a godless socialist, it was a compassionate Obama, following Christian ideals, who  pushed the legislation through.  He recognized not only the economic unsustainability of our current system, but also the moral rot at its core.

In the end a values argument carries greater weight than a practical one.  People will vote against their economic self-interest if their vote reflects their ethical universe. I believe it was a moral argument that brought Chief Justice Roberts over to the side of the four liberal judges.

Affirmation of so-called Obamacare will ultimately be recognized as an historical landmark. Like Social Security and unemployment insurance, the ACA will have far-reaching real-world consequences.  Like those other acts, it will alter our national consciousness, our assumptions of what is real and true. There will be discussions of “radical” ideas like universal coverage and the right to health care.  There will be challenges to the traditional power of pharmaceutical and insurance companies.  Even the relationship between the health of an individual and of the society will be examined. Sacred cows will be tipped, creating space for a new worldview.

The increased role of the government in the messy business of health care is sure to create bureaucratic havoc.  It will most likely drive reimbursements down to Medicare levels, threatening the sustainability of some private practices and the livelihoods of some providers. But it will also guarantee insurance to large swaths of the previously uninsurable public–whether they are Democrat, Republican, Tea Party Conservative, Libertarian, Progressive, or Independent.

Dr. Ricky Fishman has been a San Francisco based Chiropractor since 1986.  In addition to the treatment of back pain and other musculoskeletal injuries, he works as a consultant in the field of health and wellness with companies dedicated to the re-visioning of health care for the 21st century.

Copyright 2012 Ricky Fishman


5 thoughts on “Obamacare and the Future of Health (in America): Re-Visioning Health and Healing, Part Three

  1. Your initial take sounds like you’re trying to be fair and objective, it comes across as overly optimistic by my standards. I’m much more cynical. I can’t even deal with or coherently respond whenever I hear someone refer to our health-care system. I nut-up with rage and change the subject as the only way to ground myself.

    As a health care professional myself I’m disgusted by the hoops I often have to jump through to get paid and what I do gat paid which is about one third of my normal fee. As a consumer, I’m outraged by the premiums I have to pay and which increase every year as well as by the reduced services deemed not medically necessary. The biggest problem I have is my abhorrence to a “profit-based” system — the business of health care — in which the “bottom line” is always the primary consideration. As is the case with any business, profit comes before quality of care and maintaining optimal health and well-being.

    Whenever I need to consult with a doctor or must seek medical services, the question invariably gets raised, Do I really have to subject myself to this? I feel the same dread as when I have to walk into a car dealership to buy a car. I know I’m going to have to deal with people whose only interest is to make a sale, while I will do my best to not get “dinged.”

    That being said I want to learn much better how the Obama-care, Affordable Act system is going to work. My take is that the prevailing profit-based business of health care will remain intact and will only get worse. Now the government is going to be in bed with the health-care companies and become the primary source of their ever-increasing revenue streams. At best more people, those who don’t possess coverage will now be able to obtain coverage and access service, they’re going to receive the bare minimum. I don’t see any improvement whatsoever in the ease in which health-care is transacted or received, nor the quality of care improving anytime soon. The general trend will continue. It’s only getting worse. It’s only going to become more profitable and the government will become the health-care companies’ protector of their business.

  2. rickyfishman says:

    Daniel, thanks for your thoughtful and passionate comment. I actually agree with everything you say above. Yes I am being optimistic, quite possibly naively so. Being in my 27th year of health care, I am more than familiar with the realities you describe. The problem is that health care, like so much in America, is deeply embedded within a capitalistic framework which creates built in conflicts of interest throughout. I see ObamaCare as a step. A single step in the direction that this bloated health care system needs to move. And I know that this new system is going to negatively impact me as a single primary provider. What I am holding out hope for is that in the long run, things will shift. And even if it is just the language that changes, which is often necessary as a precedent to action, then we may be pointed in the direction of fairness and sustainability. We will see.

  3. Aidin says:

    Well said Ricky. It is interesting to get your perspective as someone who will be affected both as a provider and a consumer. The ACA will bring more dialogue and possibilities to improve the current healthcare mess. However I am still puzzled at how “People will vote against their economic self-interest if their vote reflects their ethical universe.” Obviously Tea Party voters are example of this disturbing trend. Having watched their interviews I have notice in several cases that their teeth are in terrible situation, while protesting against so called “Obamacare” Are these people brainwashed to vote against their own self interest? Where is the higher moral ground or ethical universe in that?

  4. rickyfishman says:

    I recently read a book called “The Righteous Mind: Why Good People Are Divided By Politics and Religion” by Jonathan Haidt, a moral psychologist. This book addresses your question and suggests that people identify with their group and that there are different values which define each group, some more important than others hierarchically. In the case of the Tea Party people I think they see individual freedom as the highest value and so anything that threatens that, including something that might work against their own economic interest, will be rejected. To your point about “brain washing” I would say in a sense we all are brain washed by the groups/cultures/society within which we are raised. How else could someone strap explosives onto their bodies and walk into a crowded marketplace to blow themselves and others up in the name of the god of their group?

  5. Whoa! Really absorbing piece of writing. So I am saving this post without delay. Thx!

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