Healthcare, Separate and Unequal?
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.