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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Healthcare, Separate and Unequal?

Published March 25, 2012 5:04 PM by Glen McDaniel

Two items of news caught my attention this weekend. Tomorrow the Supreme Court will start hearing arguments about the constitutionality of  the healthcare reform law; the so called Obamacare.   Is the Patient Protection and Affordable Care Act (P.L. 111-148) aimed at bringing basic healthcare to more Americans  or government intrusion into the free market?

Arguments pro and con largely fall along  political lines and some predict even the Supreme court ruling will be along those lines as well: the Democratically -appointed Justices will vote to uphold the law and the Republican-appointed justices will vote to repeal the law. The final outcome will be in the hands of swing justices like Justice Kennedy, the 5th judge behind many 5-4 rulings.

In a recent interview  with ADVANCE magazine, the President of ASCLS, Dr Cathy Otto, had some comments on how the law affects the medical laboratory. Her comments  are so eloquent I will quote her directly rather than paraphrase.

This is the most significant change in healthcare since Medicare and Medicaid were enacted in 1965.   If all the provisions in the law are upheld, in 2019 when the law is fully implemented it is predicted that 32 million previously uninsured individuals will have access to healthcare as a result of having health insurance.

"The Affordable Care Act will impact all aspect of the healthcare delivery system-patients, healthcare providers, insurance companies, and the Medicaid and Medicare programs.  As medical laboratory scientists, we will see an increase in laboratory test utilization as previously uninsured individuals will gain access to laboratory testing for screening and diagnostic purposes.   

Whether or not the Affordable Care Act is fully implemented, we will continue to see changes to the reimbursement for laboratory tests.  Although laboratory testing comprises only 1.6% of all health care spending, new models will be introduced and implemented for reimbursing laboratories for their services, in order to cut costs to the Medicare and Medicaid programs. 

Although in the past the laboratory professional community has been able to effectively lobby to remove a co-payment option for patients who receive laboratory testing under Medicare Part B, there is a high probability that this type of cost-sharing will be instituted to cut costs to the Medicare program.  Other types of reimbursement mechanisms to providers (including medical laboratories) and cost-sharing protocols will continue to be identified and implemented in order to address the increase in utilization of the Medicare insurance program." 

The other news item that caught my attention had to do with Vice President Dick Cheney receiving a heart transplant. There are whispered comments that he might have used undue influence to receive a transplant. He is 71 years old and hearts are a rare commodity. As someone who has served on a panel deciding who receives organs for transplants, I know the process is very rigorous. Decisions are made based on disease state, risks and benefits, patient's age, overall health and of course compatibility. Gone are the days when a powerful or rich person can simply jump to the front of the line. However, all things being equal, I have seen decisions based on how much influence is made to bear.

So these two items have made me think again about healthcare delivery in this country. Healthcare is a scarce, very expensive resource. Given the fact it is a finite resource we have to think what is a right, and what is a privilege? Why is there so much disparity based on age, gender and race? What are the ethical considerations about delivering healthcare? How much are we as laboratorians concerned with access, quality of care and equity in the delivery of healthcare?

We have a vested interest on speaking up on these issues. After all, we are consumers, healthcare providers and Americans.




We have to do something about the cost of healthcare in this country. They are always talking about socialized medicine in Europe or Canada. But those countries have much better healthcare than we do in teh states/ More people have access to care and the outcomes are better.

Healthcare reform will help to bring some of those GOOd things to the US so overall it is a good thing. Many of us are selfish we want our little piece of the pie. We want ourselves and our family to be taken care of. But we hate when others get good healthcare too. Right now the ones who benefit are greedy insurance companies and those lucky enough to have good insurance or those rich enough to pay out of pocket.

Healthcare reform would level the playing field somewhat. Plus labs would benefit from more tests and more profits.

Belinda April 17, 2012 12:26 PM
Atlanta GA

I  can see how healthcare reform will mean more testing for labs. We would need more staff and the labs would make more money, besides patients would be healthier. Many people cannot afford healthcare now so they dont go to the doctor and dont have lab tests done.

Among family and friends I know several who were diagnosed with diabetes at health fairs. If they did not get the free test they would go on living with unknown diabetes for how long?

It is remarkable to me that anyone would say healthcare reform is bad for the country. Patients would get tested quicker, labs make more money, patients are encouraged to live more healthy. How can that be bad? Anyone who has fought with an insurance company to have  anecessary treatment or denied insurance because of a preexisting condition should welcome reform and not fall for the politics.

About Dick Cheney. I dont believe for a minute he stood in line like everyone else. besides at his age how dd he get priority over say a young father with many years to live and a family to care for. Who said healthcare is equal. Not at all.

Maria Cordoza March 31, 2012 11:00 AM
Dallas TX

I am rooting for healthcare reform not to be overturned. I know for  afact that mnay people here in California have bee by the Supreme Court. Folks are playing politics but real lives will be damaged if the law is overturned. We have to stop denying people coverage because of prexisting condition. A friend's mother who is diabetic changed jobs and did not submit paperwork in time at her new job. Well they did not accept her in the pool and she had to bear all medical care herself-medication, meter, strips, lancet and doctor's visits. She had some sort of surgery on her leg and had no insurance. When she ended up on dialysis she lost her job and became bankrupt because of medical costs that medical did not cover. My friend (her daughter) used up all her savings to help but it was still not enough. That was just 2 years ago. We need a civilized system of care where this will not happen to anyone.

Jonas P mt, CLS ll March 28, 2012 8:37 PM
Los Angeles CA

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