Some Musing on Obamacare

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” ― Martin Luther King Jr.

Zealous anti-Obamacare Republicans control Congress and President Elect Trump is still promising to make the repeal a top priority once sworn in, unlike some other campaign promises he has seemingly begun to back away from. In response, rallies were held across the country yesterday in defense of “health care for all.”

singlepay
A health care rally in front of SF City Hall.

Another campaign on social media has generated numerous personal stories and pleas on how Obamacare (aka Affordable Care Act) has saved people’s lives by providing them with insurance coverage.

What’s missing, however, in these stories and discussion/debate about defending the ACA is recognition that there is still much that needs to be improved, particularly for the most vulnerable. As it is, there are around 30 million people still without insurance and too many, if not most, are underinsured. As a caretaker to someone who has a serious mental illness and various serious medical problems, I’ve seen firsthand how woefully inadequate our system still is. The question to me is: how do we defend the good things AND fight for more?

Some Egregious Problems

The expansion of Medicaid, at least in CA, has exacerbated the already high doctor to patient ratio. It took me weeks just to find a doctor when I moved my mom in with me. Dozens of providers told me they weren’t accepting anymore Medicaid patients (Medicaid is called “Medi-Cal” in CA.). When I finally found a doctor for my mom, the first available appointment was two months away. There are scattered reports that confirm this problem. And this says nothing about how difficult it is to get the doctor to respond to a phone call in a reasonable time period.

As I chronicled last January, my mom was blatantly abused and neglected by a hospital when she slipped into an acute psychotic episode. Against my wishes, as her next of kin, and despite her being in an obvious psychotic state (She didn’t even believe she was in a “real hospital.”), hospital supervisors let her sign herself out and staff wheeled her to a taxi cab. (Read the story here: Me vs. The Hospital) Understaffing is an issue. The hospital didn’t have a psychiatrist on duty at the time to do an assessment of my mom. But flagrant disregard for people with SMI and poor training are also to blame.

There is a severe shortage of psychiatric beds. In 1955, there was 1 psychiatric bed for every 300 Americans. In 2010, there was 1 psychiatric bed for every 7,100 Americas. In California, the situation is particularly stark. According to a 2012 report by the Treatment Advocacy Center, the state eliminated 16 percent of its beds between 2005 and 2010, leaving just 14.2 public psychiatric beds per 100,000 people – far below the 50-bed standard considered necessary to provide minimally adequate mental health treatment. In 25 counties in the state, there were no psychiatric beds at all. This leads to people in mental health crisis clogging up emergency rooms, and many more being warehoused in jails/prisons, which are the primary treatment centers in the country today. My mom hasn’t been successfully treated for her SMI, in large part, due to this gross shortage.

Even with insurance, the severely sick, disabled and poor are given death sentences. My mom’s physical health has deteriorated severely. She suffers from congestive heart disease, anemia, diabetes, high blood pressure and kidney problems. The lack of monitoring and coordination between her doctors is a disgrace. Her state is such that medicines are constantly being changed and she requires close and daily monitoring for any adverse changes in her condition. I shouldn’t have to go periods of weeks or months without talking with her doctors and/or receiving assistance. And without me for regular transportation to weekly doctor appointments, she’d probably already be dead.

She should be in some sort of assisted living facility. In the least, she should be receiving regular visits in the home from doctors, counselors and even clergy as part of a medical treatment team. These things are either difficult to access, due to costs, or aren’t available at all in particular counties.

Solutions

From my standpoint, we still need a drastic overhaul of our healthcare system. This includes a single-payer system that would help get healthcare costs under control and allow the government to use its leverage to negotiate reasonable prices for medications. It also includes prioritizing preventive care, adequate treatments and programs, including home visits by medical/treatment professionals, for people with substance abuse and/or mental illness, and adequate funding and staffing for hospitals. In the case of psychiatric hospitals/treatment centers, the repeal of the Institutes for Mental Disease (IMD) exclusion is an absolute necessity, in order to insure a substantial increase in funding for psychiatric hospitals.

The gains made to save and improve people’s lives under Obamacare obviously need to be defended, but not at the expense of ignoring the vast improvements that people deserve and still need to be made. Otherwise, too many are still condemned to misery and suffering.

Right now, Single Payer is a legitimate, possible alternative that would expand coverage and improve care immediately, while protecting the gains recently made with ACA. In the case of CA, Democrats have a super majority in the legislature. What a heck of a message it would send to Trump and company if CA used this opportunity to truly expand healthcare to all its residents by passing Single Payer. Check out more info. about the campaign here: https://healthycaliforniacampaign.org/

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