The Money
Without health insurance, most patients would not be able to afford medically necessary facet joint injection administered by one of the specialists at my office. Most people do not have $557-$700 in their bank account that isn’t already promised to NSTAR, Verizon, or Sallie Mae. Personally, I could not afford a face-to-face prolonged office visit ($262.00) let alone the each additional thirty minutes ($255.00). Prolonged visits are necessary when dealing with spine specialists for obvious reasons. Before someone sticks a needle in my spine, I’d like to take as long as possible to come to a diagnosis and prepare a treatment plan.
The most common obstacle to treatment and ordering diagnostic tests are the very insurance companies that patients cannot afford treatment without. They require the doctors and their staff to go through a prior authorization process that is almost always tied up in useless bureaucracy. Last week, I saw a patient who could not go for her MRI because the insurance company needed proof that it was medically necessary. Granted, doctors often order a battery of unnecessary tests and procedures, but at the specialist level most of these tests are not frivolous. An MRI can help determine if a patient has a herniated disk or something more serious like a cauda equina (which is an emergency case that requires an immediate scan).
They are a necessary evil, much like politicians. Insurance companies enrage me, baffle me, and on rare occasions bring me joy when I finally get an approval letter stating “yes you make sense, we will pay for this medically relevant drug or procedure. You are not all imbeciles that know nothing about medicine.” With the new health care bill, 31 million Americans will be covered. They too will have to endure endless hours on hold, thousands of paper cuts from all the forms they will inevitably have to fill out, and many other annoyances. But it is much better than the alternative. The argument I hear most is that it will cost taxpayers far too much, it’s only a band-aid for a festering wound, et cetera.
The 2008-09 poverty threshold for a 2 person household was $14,570. Today an Italian patient who did not have health insurance paid roughly $2,000 for their botox treatment (necessary for cerebral palsy patients to control their muscle spasms, not for cosmetic reasons) out of their own pocket. I don’t know the state of their finances but a person without health insurance who makes only $14,570/year would not be able to afford this crucial drug.*
Critics of this “shabby” bill complain that it’s been thoroughly compromised (because that’s how politics works–there’s that necessary evil again) but we have something on which to build. Economically speaking, this bill impacts both the public and private sectors.
The Congressional Budget Office claims that this bill will decrease the deficit $143 billion dollars over a time period of 10 years. It could also lower the budget deficit by 0.5% of GDP. This is actually an underestimation of savings to the numbers could come out more favorably in the long run.*
The private market also reaps some benefits because the bill encourages competition, and taxes expensive health plans as well as employers in order to provide better deals for consumers. It’s a multi-step approach to healthcare because it invests in IT and education in preventative measures people can take so that the pool of consumers that actually need insurance decreases. The CBO is quoted to say that this plan aims to “substantially reduce the growth of Medicare’s payment rates for most services” and “substantially reduce the cost of purchasing [health coverage]” for families.”*
But during a recession the primary concern for both voters and law makers is the creation of jobs. According to the White House Council of Economic Advisers this bill will generate 320,000 jobs, boost GDP growth 4%, and also increase the average family income over two decades. Within the next 10 years economists David Cutler and Neeraj Sood predict this bill could lead to the creation of somewhere between 250,000 and 400,00 jobs per year for the next ten years.*
These large-scale effects on America’s GDP and job growth are important but are not directly felt at my level. As a Patient Services Coordinator and a patient in a Boston hospital what affects me are the outcomes at my level. The President of this hospital sent an e-mail to the entire facility detailing the changes that will take place.
The reform bill provides federal subsidies for health insurance to individuals and families with incomes up to 400% of the federal poverty level (FPL). Currently, Massachusetts provides subsidies to individuals and families with incomes up to 300% of FPL. Therefore, the increase in subsidies from 300% to 400% could cover approximately 75,000 more people in Massachusetts. This means more patients can come to our hospital, thus increasing revenue.
When I am at work, trying to hide behind my computer monitor from a particularly irate patient the complaints I hear regarding the bill have nothing to do with subsidies, the creation of jobs, or sweeping legislation that will save millions of poor people from medical neglect. I hear about a group of nuns that challenge bishops over abortion, an attractive woman who is in charge of controlling the Democrats, and of course how people wonder why anyone voted for Obama in the first place.
The Controversy
The bill is largely a Democratic victory but 11 supporters, including Rep. Bart Stupak (D-Mich.) wanted to ensure that no Federal funds were allocated for abortions.* The representatives, along with a group of Roman Catholic bishops, felt that the Senate version of the legislation didn’t limit federal subsidies for insurance companies that cover abortions. Interestingly enough, a group of progressive Catholic nuns felt otherwise. This group of 50 nuns differed from the US Conference of Catholic Bishops. This divide seems confusing because both the nuns and bishops stand firmly against the practice of abortions but there is a rift between them regarding the legislation’s language.*
It baffles Sister Simone Campbell who is the executive director of Network (a religiously affiliated social justice lobbying organization). She and her group supported the bill but is anti-abortion. Her main point was that the Senate’s bill wouldn’t necessarily make abortions accessible to more people, but rather, she was worried about “the people who live at the margins of health care in society.”*
On the other side of the divide stands Cardinal Francis George, president of the US Conference of Catholic Bishops. In his written statement he said “[The bill] forces all of us to become involved in an act that profoundly violates the conscience of many, the deliberate destruction of unwanted members of the human family still waiting to be born.” It is not enough that the Senate bill (which was basically the blueprint for the House bill) doesn’t go far enough, it taints those involved because it allows states to ban the use of federal subsidies to buy insurance plans that cover abortions.
The Politicians
Abortion is both a domestic and international issue. People feel so strongly about abortion that protesters from a group called The Vanguard of St. Catherine of Siena want the Pope to excommunicate Nancy Pelosi. Randall Terry, the leader of the Vanguard said “This bill is the most horrific treachery against life since Roe versus Wade. I would hate to be in Nancy Pelosi’s shoes on the Day of Judgment”.* This group was in Rome asking Catholic officials to stop the distribution of Communion to pro-choice politicians on the grounds that the Church must require American bishops to adhere to Canon 915, which prohibits giving Communion to those “who obstinately persist in manifest grave sin.”
Back in March, the RNC chairman Michael Steele, said: “The bottom line is, if you want to try to undo a lot of the damage that’s being done, or that’s being planned to be done under this bill, Nancy Pelosi has to be fired.”* Pelosi is not the only Democrat responsible for the success of “Obamacare” but the opposition targets her because as Speaker of the House she is the leader of the majority party and sets the tone for the party’s legislative schedule.
On the other hand others view Pelosi as a “Ninja Legislator.”* History may vilify her or recognize that she was able to unite a party that doesn’t vote as a bloc, acknowledge the feat of becoming the first female Speaker and the highest ranking female politician in America.
Pelosi risked her political career supporting this bill, but so did Obama. The cost of this bill is the primary concern to tax payers, but yet another cost exists for Obama and his supporters: how much political capital did Obama use up in order to get this bill passed? A year and a half ago, President Obama hoped for a “post-partisan” Washington but while attempting to pass healthcare reform, partisan squabbles resurfaced. Obama can’t control everyone inside his party or outside it; he is not to blame if some people feel it appropriate to scream “baby killer” and “you lie” in the middle of proceedings.
The remarkable thing about this bill isn’t just all the controversy it stirred up, but the fact that it’s a major piece of legislation that passed without one Republican vote. President Johnson had nearly half of the Republicans in the House vote for Medicare. Washington’s changed, and Obama’s dream of having a harmonious government that lacks party bickering will never come true. Peter Beinart, a liberal essayist, asserts that “he’s failed in the effort to be the nonpolarizing president, the one who can use rationality and calm debate to bridge our traditional divides.”*
Obama paid a price to learn that “postpartisan” Washington won’t work. He almost lost the health care debate, he put every other priority on the back-burner to do so. With this move, he could have ruined himself and those Democrats who support him. However, he needed a legislative victory to back up his campaign slogan, “Change You Can Believe In.”
The Republicans think that health care reform is a prime example of how the president wants to use big government to intrude into American citizens’ lives. Peter Wehner, a political adviser to former President Bush, thinks that “[in] the short term Obama will get a boost, because the narrative is that he came back from the dead and got done what no president has managed to do in 70 years. But once people discover that their Medicare taxes are going up, that there are deeper cuts in Medicare Advantage, that there are court challenges to many provisions, and that the process of getting it passed created a portrait of corruption, it won’t sit well.”*
But historically, that is not the case. After Medicare was created in 1966 it covered 20 million Americans. Johnson recalled that people said Social Security “would destroy this country,” but “there is not one out of 100 who would think of repealing it.”*
Unfortunately, we must wait years to see the outcome of this bill. Will the Republicans be right about government meddling or will affordable, near-universal coverage become a reality? Obama used much of his political capital to fight for something he believed in, risking it all to make his campaign promise into viable legislation.
There may be court challenges coming from the Republican party in the years to come. It may go down in our children’s history books as an act of political suicide for the president and his party, but he did something that President Clinton could not. He succeeded where Bush failed with his attempt to create private accounts in the Social Security system. We’ll just have to wait and see how this all pans out. Obamacare is flawed and needs improvement, but it is at least an attempt to tackle the problem. Future politicians will – hopefully – not have to start from scratch.
***
Shahrin Ahsan
Shahrin Ahsan is 23 years old and lives in Beantown, MA, where she works in clinical research. She recently graduated from Simons College with degrees in biochemistry and vocal performance. She was born in Bangladesh. Her ideal career involves the World Health Organization. Her favorite author is Ernest Hemingway.
Mount Saint Helens Did Not Erupt on My Birthday posted on January 11, 2012 
A Break in a Journey posted on January 1, 2012 
Softly posted on December 7, 2011 
The Big Blue posted on January 20, 2012 
She’s Not Mine posted on February 3, 2012 
One posted on December 28, 2011
Money, Controversy, and Politics: The Passage of Healthcare Reform
by Shahrin Ahsan Pereira on May 17, 2010 • 12:00 pm No CommentsThe Money
Without health insurance, most patients would not be able to afford medically necessary facet joint injection administered by one of the specialists at my office. Most people do not have $557-$700 in their bank account that isn’t already promised to NSTAR, Verizon, or Sallie Mae. Personally, I could not afford a face-to-face prolonged office visit ($262.00) let alone the each additional thirty minutes ($255.00). Prolonged visits are necessary when dealing with spine specialists for obvious reasons. Before someone sticks a needle in my spine, I’d like to take as long as possible to come to a diagnosis and prepare a treatment plan.
The most common obstacle to treatment and ordering diagnostic tests are the very insurance companies that patients cannot afford treatment without. They require the doctors and their staff to go through a prior authorization process that is almost always tied up in useless bureaucracy. Last week, I saw a patient who could not go for her MRI because the insurance company needed proof that it was medically necessary. Granted, doctors often order a battery of unnecessary tests and procedures, but at the specialist level most of these tests are not frivolous. An MRI can help determine if a patient has a herniated disk or something more serious like a cauda equina (which is an emergency case that requires an immediate scan).
They are a necessary evil, much like politicians. Insurance companies enrage me, baffle me, and on rare occasions bring me joy when I finally get an approval letter stating “yes you make sense, we will pay for this medically relevant drug or procedure. You are not all imbeciles that know nothing about medicine.” With the new health care bill, 31 million Americans will be covered. They too will have to endure endless hours on hold, thousands of paper cuts from all the forms they will inevitably have to fill out, and many other annoyances. But it is much better than the alternative. The argument I hear most is that it will cost taxpayers far too much, it’s only a band-aid for a festering wound, et cetera.
The 2008-09 poverty threshold for a 2 person household was $14,570. Today an Italian patient who did not have health insurance paid roughly $2,000 for their botox treatment (necessary for cerebral palsy patients to control their muscle spasms, not for cosmetic reasons) out of their own pocket. I don’t know the state of their finances but a person without health insurance who makes only $14,570/year would not be able to afford this crucial drug.*
Critics of this “shabby” bill complain that it’s been thoroughly compromised (because that’s how politics works–there’s that necessary evil again) but we have something on which to build. Economically speaking, this bill impacts both the public and private sectors.
The Congressional Budget Office claims that this bill will decrease the deficit $143 billion dollars over a time period of 10 years. It could also lower the budget deficit by 0.5% of GDP. This is actually an underestimation of savings to the numbers could come out more favorably in the long run.*
The private market also reaps some benefits because the bill encourages competition, and taxes expensive health plans as well as employers in order to provide better deals for consumers. It’s a multi-step approach to healthcare because it invests in IT and education in preventative measures people can take so that the pool of consumers that actually need insurance decreases. The CBO is quoted to say that this plan aims to “substantially reduce the growth of Medicare’s payment rates for most services” and “substantially reduce the cost of purchasing [health coverage]” for families.”*
But during a recession the primary concern for both voters and law makers is the creation of jobs. According to the White House Council of Economic Advisers this bill will generate 320,000 jobs, boost GDP growth 4%, and also increase the average family income over two decades. Within the next 10 years economists David Cutler and Neeraj Sood predict this bill could lead to the creation of somewhere between 250,000 and 400,00 jobs per year for the next ten years.*
These large-scale effects on America’s GDP and job growth are important but are not directly felt at my level. As a Patient Services Coordinator and a patient in a Boston hospital what affects me are the outcomes at my level. The President of this hospital sent an e-mail to the entire facility detailing the changes that will take place.
The reform bill provides federal subsidies for health insurance to individuals and families with incomes up to 400% of the federal poverty level (FPL). Currently, Massachusetts provides subsidies to individuals and families with incomes up to 300% of FPL. Therefore, the increase in subsidies from 300% to 400% could cover approximately 75,000 more people in Massachusetts. This means more patients can come to our hospital, thus increasing revenue.
When I am at work, trying to hide behind my computer monitor from a particularly irate patient the complaints I hear regarding the bill have nothing to do with subsidies, the creation of jobs, or sweeping legislation that will save millions of poor people from medical neglect. I hear about a group of nuns that challenge bishops over abortion, an attractive woman who is in charge of controlling the Democrats, and of course how people wonder why anyone voted for Obama in the first place.
The Controversy
The bill is largely a Democratic victory but 11 supporters, including Rep. Bart Stupak (D-Mich.) wanted to ensure that no Federal funds were allocated for abortions.* The representatives, along with a group of Roman Catholic bishops, felt that the Senate version of the legislation didn’t limit federal subsidies for insurance companies that cover abortions. Interestingly enough, a group of progressive Catholic nuns felt otherwise. This group of 50 nuns differed from the US Conference of Catholic Bishops. This divide seems confusing because both the nuns and bishops stand firmly against the practice of abortions but there is a rift between them regarding the legislation’s language.*
It baffles Sister Simone Campbell who is the executive director of Network (a religiously affiliated social justice lobbying organization). She and her group supported the bill but is anti-abortion. Her main point was that the Senate’s bill wouldn’t necessarily make abortions accessible to more people, but rather, she was worried about “the people who live at the margins of health care in society.”*
On the other side of the divide stands Cardinal Francis George, president of the US Conference of Catholic Bishops. In his written statement he said “[The bill] forces all of us to become involved in an act that profoundly violates the conscience of many, the deliberate destruction of unwanted members of the human family still waiting to be born.” It is not enough that the Senate bill (which was basically the blueprint for the House bill) doesn’t go far enough, it taints those involved because it allows states to ban the use of federal subsidies to buy insurance plans that cover abortions.
The Politicians
Abortion is both a domestic and international issue. People feel so strongly about abortion that protesters from a group called The Vanguard of St. Catherine of Siena want the Pope to excommunicate Nancy Pelosi. Randall Terry, the leader of the Vanguard said “This bill is the most horrific treachery against life since Roe versus Wade. I would hate to be in Nancy Pelosi’s shoes on the Day of Judgment”.* This group was in Rome asking Catholic officials to stop the distribution of Communion to pro-choice politicians on the grounds that the Church must require American bishops to adhere to Canon 915, which prohibits giving Communion to those “who obstinately persist in manifest grave sin.”
Back in March, the RNC chairman Michael Steele, said: “The bottom line is, if you want to try to undo a lot of the damage that’s being done, or that’s being planned to be done under this bill, Nancy Pelosi has to be fired.”* Pelosi is not the only Democrat responsible for the success of “Obamacare” but the opposition targets her because as Speaker of the House she is the leader of the majority party and sets the tone for the party’s legislative schedule.
On the other hand others view Pelosi as a “Ninja Legislator.”* History may vilify her or recognize that she was able to unite a party that doesn’t vote as a bloc, acknowledge the feat of becoming the first female Speaker and the highest ranking female politician in America.
Pelosi risked her political career supporting this bill, but so did Obama. The cost of this bill is the primary concern to tax payers, but yet another cost exists for Obama and his supporters: how much political capital did Obama use up in order to get this bill passed? A year and a half ago, President Obama hoped for a “post-partisan” Washington but while attempting to pass healthcare reform, partisan squabbles resurfaced. Obama can’t control everyone inside his party or outside it; he is not to blame if some people feel it appropriate to scream “baby killer” and “you lie” in the middle of proceedings.
The remarkable thing about this bill isn’t just all the controversy it stirred up, but the fact that it’s a major piece of legislation that passed without one Republican vote. President Johnson had nearly half of the Republicans in the House vote for Medicare. Washington’s changed, and Obama’s dream of having a harmonious government that lacks party bickering will never come true. Peter Beinart, a liberal essayist, asserts that “he’s failed in the effort to be the nonpolarizing president, the one who can use rationality and calm debate to bridge our traditional divides.”*
Obama paid a price to learn that “postpartisan” Washington won’t work. He almost lost the health care debate, he put every other priority on the back-burner to do so. With this move, he could have ruined himself and those Democrats who support him. However, he needed a legislative victory to back up his campaign slogan, “Change You Can Believe In.”
The Republicans think that health care reform is a prime example of how the president wants to use big government to intrude into American citizens’ lives. Peter Wehner, a political adviser to former President Bush, thinks that “[in] the short term Obama will get a boost, because the narrative is that he came back from the dead and got done what no president has managed to do in 70 years. But once people discover that their Medicare taxes are going up, that there are deeper cuts in Medicare Advantage, that there are court challenges to many provisions, and that the process of getting it passed created a portrait of corruption, it won’t sit well.”*
But historically, that is not the case. After Medicare was created in 1966 it covered 20 million Americans. Johnson recalled that people said Social Security “would destroy this country,” but “there is not one out of 100 who would think of repealing it.”*
Unfortunately, we must wait years to see the outcome of this bill. Will the Republicans be right about government meddling or will affordable, near-universal coverage become a reality? Obama used much of his political capital to fight for something he believed in, risking it all to make his campaign promise into viable legislation.
There may be court challenges coming from the Republican party in the years to come. It may go down in our children’s history books as an act of political suicide for the president and his party, but he did something that President Clinton could not. He succeeded where Bush failed with his attempt to create private accounts in the Social Security system. We’ll just have to wait and see how this all pans out. Obamacare is flawed and needs improvement, but it is at least an attempt to tackle the problem. Future politicians will – hopefully – not have to start from scratch.
***
Shahrin Ahsan
Shahrin Ahsan is 23 years old and lives in Beantown, MA, where she works in clinical research. She recently graduated from Simons College with degrees in biochemistry and vocal performance. She was born in Bangladesh. Her ideal career involves the World Health Organization. Her favorite author is Ernest Hemingway.