By Mary Minor / For The Herald
With apologies to Joni Mitchell, I’ve seen the gurney from both sides now.
In the early ’80s, I studied naturopathic medicine at Bastyr University in Kenmore. A teacher of mine often joked, “If you ever get diagnosed with cancer, don’t call your doctor, call your travel agent.” That line always got a laugh. Then, I was diagnosed with cancer.
Thirty years later, as I was being wheeled into the operating room, my surgeon, Joanie Hope, leaned over the gurney and reassured me, “I’m going to take good care of you.”
“I know you will,” I replied.
That’s what medicine is supposed to be about. A trusting relationship between patient and provider. At no point should the grinding stress of financial ruin be layered on top of the hard work of not dying. And it’s why health care should be on the minds of voters this elections season.
In my practice, I’ve often told patients, “I can’t dictate what you can afford, but this is what you need.” When I was a student, I didn’t realize the significant impact cost would have on deciding which tests and procedures, even routine ones, to order. Like many in the medical field, my primary desire was to assist people in line with my training.
If nothing else, covid-19 has shown that our health care providers are exceptional, with nurses donning garbage bags, refrigerator trucks filled with bodies, and a sense of building the plane while flying it. They indeed rose to the occasion.
It also revealed a couple of glaring flaws. Not everyone has access to care, despite the Affordable Care Act, and it is unbelievably expensive when compared to the rest of the world
Even though the U.S. spends more, a lot more, on health care than any other country, we are not a nation of healthy people.
“There has been a longstanding tension between medicine as a profession and health care as a business,” said Yashaswini Singh, a health care economist at Johns Hopkins University. “The key concern has always been that business obligations to shareholders might not align with physicians’ obligations to patients.”
Health care expenditures, measured as a percentage of GDP, rose from 5 percent in 1960 to 17.3 percent in 2022. That’s a significant sum of money, predominantly managed by private equity funds, hedge fund managers, and pharmacy benefit managers. One might wonder, what could possibly go wrong?
How we got here: The Patient Protection and Affordable Care Act of 2010, also known as Obamacare, has made strides in addressing the issue of access to health insurance for those who cannot afford it. The strategy includes expanding Medicaid — a move adopted by most but not all states — established a marketplace for individual health insurance, and offered subsidies to reduce the cost of policies. The uninsured rate decreased from 17.8 percent in 2010 to 8 percent in 2022, according to KFF, a significant benefit for the insurance industry.
The Families First Coronavirus Response Act, enacted during the Trump administration, mandated continuous Medicaid enrollment throughout the covid-19 pandemic. As of April 2023, an estimated 25 million individuals, including a significant number of children, were dis-enrolled from health coverage, according to KFF.
Under the Biden administration, the American Rescue Plan and the Inflation Reduction Act have extended ACA subsidies until 2025, offering an average annual saving of $800 to 13 million people.
Republican plans: It’s known that in the summer of 2017, Congressional Republicans attempted unsuccessfully to dismantle Obamacare. This time around, Republican presidential nominee Donald Trump isn’t focusing on repeal-and-replace rhetoric, but he claims to have “concepts of a plan” as he said in Tuesday’s presidential debate.
What we do have to refer to is Project 2025, an initiative developed by the conservative Heritage Foundation, aimed at influencing Trump as president. Despite Trump’s denial of any knowledge of this play book, many of those involved in Project 2025 have ties to his past administration. The health care aspects focus predominantly on contentious cultural issues such as abortion, gender-affirming care and fetal tissue research. It also proposes extensive changes to agencies such as Health and Human Services, National Institutes of Health and the Centers for Disease Control and Prevention.
In March of this year, the budget proposed by the Republican Study Committee in the House of Representatives, if enacted, would have cut $4.5 trillion from the Affordable Care Act, Medicaid, and the Children’s Health Insurance Program (CHIP). Additionally, it would have removed certain protections for consumers, the elderly, and individuals with disabilities, according to a March 2024 White House briefing.
Democratic plans: The Biden administration has primarily concentrated on managing the costs of prescription drugs such as insulin for Medicare recipients. While this approach may be beneficial in the short term and on a superficial level, it does not address the core issue. The negative impact of banks being “too big to fail” is well-known, but the consequences are far more severe when hospital chains reach such a magnitude. This principle also extends to medical appliance manufacturers, Big Pharma, and hospitals that claim non-profit status.
During her tenure as California’s attorney general, Kamala Harris was an active opponent of health care consolidation for seven years. It is anticipated she will seek methods to restrict private equity ownership of health care facilities, prioritizing public health over shareholder interests.
During her 2020 campaign for the Democratic presidential nomination, Harris endorsed a “Medicare for all” plan among several proposals. Subsequently, she has aligned with the Biden Administration’s strategy to expand coverage under the Affordable Care Act. The progressive members of the caucus are expected to persist in their advocacy for a single-payer option.
My take: It has been seven years, six months and twenty-one days since I was wheeled into that operating room and had that exchange with my doctor and friend Joanie Hope, and to date I have no evidence of disease. I am lucky. I know that.
I believe everyone deserves equal access to quality care and expertise. That’s why I pay attention to what political candidates promise, but I place greater importance on their actions. Health is on the ballot.
Mary Minor is a naturopathic physician, health coach, and health care science writer living in Snohomish.
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