The United States of America joined the league of modern nations Sunday when its political leaders finally passed legislation to provide health insurance to almost every American. In a historic vote, the House of Representatives gave final approval to the greatest expansion of health insurance here since the early 1960s. While much remains to be decided, fought over and sued over, such momentous changes have a ratchet effect; insuring 32 million people may be difficult to achieve, but it will prove even harder to undo.
In taking this step, Congress acted like a bunch of emergency physicians taking care of a severely injured, combative patient (in this case, the U.S. health care system). They administered sedatives and paralytics, knocked the struggling patient out, stuck a breathing tube down the windpipe, and took control of the chaos so they could take care of the patient.
In the emergency department, with the patient now quiet and the crucial function of getting oxygen into the lungs under control, the team then can systematically identify all of the injuries and prioritize treatment based on how great a threat each injury is to the patient.
In health care, by passing legislation that insures most Americans and bans insurance companies from booting patients with pre-existing conditions off their rolls, Congress has provided each American with the most important medical treatment of all: health insurance. By doing so, it has also started to bring the chaos of our health care system under better control so the real work of reform can now begin.
Up to this point, the system had one real escape valve for the underlying problem of uncontrolled health care costs; if a company could not afford to insure its workers, or an insurance company found a patient too expensive, sooner or later the health insurance got yanked. If an individual found health insurance unaffordable, he or she dropped it. This is the bailout model of health insurance affordability — make health insurance for some affordable by bailing out of health insurance for others.
That bailout escape valve has been a huge source of chaos in the care of our health system patient, causing tremendous personal and social disruption while distracting us from other problems. Lack of insurance kills an estimated 50,000 Americans every year and bankrupts about a million others. More importantly in some ways, the bailout option allowed us to continue to ignore the biggest problem of all — our unsustainable hemorrhage of national and personal wealth to pay for rising health care costs.
By progressively eliminating health insurance bailout options, the new law ultimately will force us to figure out how to make health insurance for all affordable, individually and collectively. That, in turn, will force us all to start dealing effectively with the real cause of all our pain, unaffordable health care costs. If we don’t, we will have delivered oxygen and saved the patient for the moment, only to then see him bleed to death.
Controlling those costs, and thereby making insurance affordable for all, will be brutally difficult work. There will be plenty to fight plenty hard about for those eager to continue health care fights. But cost control fights are better than fighting over whether every American should be insured, over whether a person who has worked hard all his life should be financially ruined because some idiot drives into him on a country road, or over whether someone should die for lack of cancer treatment she could not afford. Perhaps we can now put that fight behind us.
In the trauma room of the ER, once the patient is sedated, the airway is secured and oxygen is being delivered, the team often pauses and surveys the situation. We can congratulate each other briefly for having done, if not the hardest work, at least the most important work to that point. We can check and recheck what we have done so far, fine-tuning and improving it. We can take an inventory of work remaining to be done and prioritize it, slow racing pulses, and take some slow, deep breaths.
Then we can get back to work.
Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He is also the interim CEO at Blue Hill Memorial Hospital.