It is past time.
Dr. Atul Gawande, a Harvard surgeon and medical writer of bipartisan acclaim, recently termed the dysfunction of our health-care system a "wicked problem." Wicked problems are a class of problems that are, he said, "messy, ill-defined, ... complex ... and open to multiple interpretations based on one's point of view." Examples include poverty, obesity, "or how to provide all our citizens with adequate health care."
For too many decades our country has not been able to even agree on how to begin to solve the health-care crisis. With the passage of the Affordable Care Act (ACA) two years ago, Dr. Gawande declared, "We did something about it."
What is striking to me about the ACA is how it directly addresses the most unjust provisions of private health insurance. As a result of ACA, you and your child cannot be turned down from affordable coverage for a preexisting condition. A woman cannot be charged more than a man for the same coverage. Policyholders cannot be dropped because they get sick. And there can be no annual or lifetime caps on coverage.
When the Supreme Court upheld most of the ACA, the American Cancer Society affirmed it as "a victory for people with cancer and their families." The American Psychiatric Association asserted, "This will protect the rights of individuals with mental illness to have access to appropriate care."
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Most of my professional career has been spent caring for women. The benefits of the ACA for women are heartening, including comprehensive preventative and screening services without co-pays. Why this is so important is that we know from work in developing countries that to improve the lot of women is to improve the health, prosperity and economy of the whole country. Freely available contraception is counted as a benefit for women, which it is, but this is mis-
categorized. Contraception is surely a human responsibility and not solely a woman's issue.
Much of the ACA was modeled after the health-care plan then-Gov. Mitt Romney instituted in Massachusetts. In April 2006 Romney signed the bill, requiring every citizen in his state to buy health insurance.
Romney said, "It's a Republican way of reforming the market. Because, let me tell you, having 30 million people in this country without health insurance and having those people show up when they get sick and expect someone else to pay, that's a Democratic approach. That's the wrong way. The Republican approach is to say, 'You know what? Everybody should have insurance. They should pay what they can afford to pay. If they need help, we will be there to help them, but no more free
ride.' "
In his 2010 book, "No Apology," Romney reviewed the success of his health plan in Massachusetts, writing, "We can accomplish the same thing for everyone in the country." In the newer paperback edition, this last line is deleted.
It is easy to adopt the rhetoric of intransigence that historically has been used against any expansion of human rights -- that the reforms will fail, that they only will make the problem worse or that they will impose unacceptable costs on society. The ACA is only a start in solving this "wicked" problem, but it is a substantial start. If we want to continue to claim American exceptionalism in this increasingly globalized world we will have to ensure the health of our whole population. I fear that if the ACA is repealed, as Gov. Romney has vowed to do beginning the first day of his administration, meaningful health reform will have to wait for another generation.
It is past time.
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Dr. Atul Gawande, a Harvard surgeon and medical writer of bipartisan acclaim, recently termed the dysfunction of our health-care system a "wicked problem." Wicked problems are a class of problems that are, he said, "messy, ill-defined, ... complex ... and open to multiple interpretations based on one's point of view." Examples include poverty, obesity, "or how to provide all our citizens with adequate health care."
For too many decades our country has not been able to even agree on how to begin to solve the health-care crisis. With the passage of the Affordable Care Act (ACA) two years ago, Dr. Gawande declared, "We did something about it."
What is striking to me about the ACA is how it directly addresses the most unjust provisions of private health insurance. As a result of ACA, you and your child cannot be turned down from affordable coverage for a preexisting condition. A woman cannot be charged more than a man for the same coverage. Policyholders cannot be dropped because they get sick. And there can be no annual or lifetime caps on coverage.
When the Supreme Court upheld most of the ACA, the American Cancer Society affirmed it as "a victory for people with cancer and their families." The American Psychiatric Association asserted, "This will protect the rights of individuals with mental illness to have access to appropriate care."
Most of my professional career has been spent caring for women. The benefits of the ACA for women are heartening, including comprehensive preventative and screening services without co-pays. Why this is so important is that we know from work in developing countries that to improve the lot of women is to improve the health, prosperity and economy of the whole country. Freely available contraception is counted as a benefit for women, which it is, but this is mis-
categorized. Contraception is surely a human responsibility and not solely a woman's issue.
Much of the ACA was modeled after the health-care plan then-Gov. Mitt Romney instituted in Massachusetts. In April 2006 Romney signed the bill, requiring every citizen in his state to buy health insurance.
Romney said, "It's a Republican way of reforming the market. Because, let me tell you, having 30 million people in this country without health insurance and having those people show up when they get sick and expect someone else to pay, that's a Democratic approach. That's the wrong way. The Republican approach is to say, 'You know what? Everybody should have insurance. They should pay what they can afford to pay. If they need help, we will be there to help them, but no more free
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*ide.' "
In his 2010 book, "No Apology," Romney reviewed the success of his health plan in Massachusetts, writing, "We can accomplish the same thing for everyone in the country." In the newer paperback edition, this last line is deleted.
It is easy to adopt the rhetoric of intransigence that historically has been used against any expansion of human rights -- that the reforms will fail, that they only will make the problem worse or that they will impose unacceptable costs on society. The ACA is only a start in solving this "wicked" problem, but it is a substantial start. If we want to continue to claim American exceptionalism in this increasingly globalized world we will have to ensure the health of our whole population. I fear that if the ACA is repealed, as Gov. Romney has vowed to do beginning the first day of his administration, meaningful health reform will have to wait for another generation.
Dr. Judith Arvold is a general internist who retired this year after 33 years of practice in Duluth.
