BY DR. ANN SETTGAST
The day the Affordable Care Act (ACA) was upheld by the Supreme Court was ironic for me as a physician. Two of my patients asked me to prescribe medication for uninsured family members: A mother asked me for an inhaler for her adult son with uncontrolled asthma, and another asked me if I could refill her husband’s blood pressure medications for a month or two until he is able to find another job following his lay off. He cannot see his doctor due to his uninsurance.
One might think I felt better at the end of that morning clinic knowing the ACA had been upheld. But, I didn’t. You see, even with the ACA in place, we have no reason to believe these two men will obtain access to care. In Minnesota, more than 250,000 will remain uninsured after the ACA’s implementation. These Minnesotans will remain invisible like the family members I describe, and some of them may die. After all, uninsurance is a risk factor for preventable death in the United States. However, this is not the only problem. Thousands more will remain underinsured. Any practicing physician can tell stories about underinsurance —we see it when recommendations we make to our insured patients are not taken because the deductible hasn’t been met or the co-pay is unaffordable. Minnesota ranks second in the nation for uptake of high-deductible plans, so underinsurance here is alive and well.
I hate to be a spoilsport while many are celebrating the Supreme Court’s decision, but the truth is, as a society, we have again sold ourselves short. Here, in this incredibly wealthy nation with vast resources, rather than actually fixing the problem, we will continue to allow patients to forgo needed care because of cost. We have still not joined other wealthy nations in recognizing health care as a human right.
It has been disheartening to hear post-ruling commentary on both sides of the ACA debate because much of it simply isn’t true. One politician actually claimed that now the U.S. was joining all other industrialized countries in finally providing universal care … but more than 20 million Americans will be uninsured if the ACA is fully enacted. I need not spell out the blatant falsehood here. I’ve also heard that now, Americans will not face medical ruin because of healthcare costs. Again, the facts simply belie the statement. The medical bankruptcy rate in Massachusetts did not budge with implementation of the mandate there. That state, now with the lowest uninsurance rate in the nation, also boasts the highest per capita costs. Forcing people to buy skimpy policies that leave them without proper access to care and vulnerable to financial ruin is not meaningful reform. Rather, it is perpetuation of our current dysfunction.
In Minnesota, we can and should hold ourselves to a higher standard. By enacting a single-payer, Medicare-for-All system, we could show the nation what happens when individuals flourish and fulfill their productive potential without the fear of financial ruin should they become ill. By severing our unhealthy relationship with a private insurance industry that amasses great wealth at the expense of sick patients, we can save a tremendous amount of money and actually spend it on health care. The Lewin study, earlier this year, showed us that the administrative simplicity of a single-payer in Minnesota would save our state $4 billion annually while covering everyone with comprehensive care. Now that’s a solution I could celebrate.
Ann Settgast is a primary care doctor practicing in St. Paul. She represents Physicians for a National Health Program’s Minnesota chapter which now has nearly 1,000 physician and medical student members.