I’ll never forget the way his chest X-ray looked.
During my usual night shift at the hospital, an individual around my age came in seeking care for a bad cough. He told me he worked as a drywall installer in dusty environments and had no health insurance, much less the ability to take time off from his job to get better. The cough had persisted for the past year, he said, and was beginning to bring up some blood.
In a separate room, not long before midnight, I clipped his X-ray film to the wall. A grapefruit-sized mass in his upper-right lung glared back at me. My heart sank. When I walked back into the patient’s room and explained as gently as possible the dire situation he faced, he responded: “When can I get back to work?”
The interaction I just described occurred in 2006 – prior to the passage of the Affordable Care Act. Today, I am one of just two physicians currently serving in the Minnesota Legislature. As someone who has worked on the front lines of health care both before and after the ACA, I never want to see us go back to the dark days when private insurers canceled insurance policies, or didn’t provide them at all, for people facing serious medical crises.
If the ACA had existed when I met that drywall installer back in 2006, he could have visited his doctor for annual preventive exams at no cost. It’s possible a physician or nurse could have identified occupational health hazards, spotted warning signs, and helped that man prevent a personal health catastrophe. Perhaps his first question after I broke that horrible news in 2006 would not have been how will I pay my bills, but rather how soon he could begin treatment.
The ACA significantly reduced the number of Americans without health insurance and established important consumer protections that benefit everybody. With the steep rise in demand for medical care there have been correlated cost increases. Private insurers continue to raise their prices in the form of higher premiums and deductibles for consumers, even as they rake in record profits.
Government can and must now work to control health care costs for consumers. Our hopes that insurance companies would hold costs down has proven misguided.
I favor regulating prescription drug companies, driving doctors toward the best and most efficient practices (such as preventive medicine), and incentivizing hospitals to keep people out of beds, not fill more beds. Controlling costs can be done hand in hand with great medical care. That’s why I favor an expansion of our state’s popular MinnesotaCare program as an option for increasing choice and competition in our state health insurance market.
MinnesotaCare is a state program that for 26 years has provided affordable, reliable health care for eligible working families. People pay what they can toward their monthly premiums and the state helps them out based on their income level. The program is proven to control costs and drive providers toward quality health delivery. By creating an option for all consumers to “buy in” to MinnesotaCare, those who earn too much to qualify for subsidies would pay their own way, meaning the cost of their premiums would pay for their coverage just like other commercial insurance plans.
Two powerful industries oppose the MinnesotaCare Buy-In idea – private insurance companies and hospitals. Why? Because an affordable product like MinnesotaCare cuts into their profits. Any disruption to the fee-for-service model is guaranteed to result in industry pushback.
Some politicians have proposed we control the costs of health insurance by offering products that only cover some conditions, or can be revoked if a person has a pre-existing condition. As a doctor, I can attest that every one of us will have a pre-existing condition at some point in our lifetimes. Removing consumer protections for any medical condition is a shortsighted gimmick that will turn us back to days like the one when I discovered the mass in the drywall installer’s lung. When we structure health insurance to only serve the healthy, nobody who needs it will have it.
We are a strong enough and a good enough state to ensure all of us have access to health care. And we can no longer allow a person’s background or income to determine if they can receive treatment – we are better than that. Let’s move forward, not backward, with health coverage for Minnesotans.
This commentary was originally published by MinnPost.