Ruminations about the Affordable Care Act reminded me of a situation I dealt with during an annual legislative session. As the health commissioner for the jurisdiction, I had been asked to comment on a number of bills that related to health. It was interesting to work with this material because in some cases there was good public health policy precedent for the proposed change to the law, while in other cases the bill was a neonate, born often from a place unknown to many of us who read them. It was in the deciphering of these bills that we found strength in our collective skills and talents. {Aside - this reminds me that in a later post I must discuss the need for diversity in those teams.} Together, we would plod through the language of the bill to find the heart of the matter, and then decide if the recommendation had merit (usually based on our daily operations and our experience).
Most of the time we are able to clearly state our position on a given proposal. Sometimes we recommend amendments as a way to strengthen the bills. Sometimes I would pick up the phone to call our intermediary and tell her how crazy (or brilliant) a particular bill was so she could work her magic and get things moving. There were however rare occasions when we find ourselves in a bit of a spot.
The example of this that comes to mind is a bill that sought to increase access to care for youth in our state. A fine idea. The problem was that at the local level we were already woefully behind on taking care of the existing eligible individuals in this already large and needy group. It was not for lack of desire or effort, but rather a simple math problem. Too many cases for too few case-workers. Sure, we could work harder, but we were hitting the rev-limiter everyday. Maybe we could work smarter, an eternal question with a number of confounders, but suffice it to say, some research needed to be done to see if this was the case.
One option at our immediate disposal was to simply oppose the bill on the grounds that we did not see a way out of our existing case load, and that adding cases would stress the system too much. In doing so, we ran the risk of being labeled as oppositional to the popular public health concept of universal health care access. Alternately, we could support the bill, risk having any qualifying amendments be forgotten under the umbrella statement that “county X is in support of bill xyz”. We went for option #2, to support the proposal, even given our tenuous position. In my opinion, to stand against the principle of universal access was to suggest that we did not embrace the concept.
This scenario is playing itself out on a larger scale now as we deal with the pending implementation of the "Obama-care" package, and the prospect of adding patients to a system that is ill prepared to receive them. Back then, our support for these sorts of measures left us wanting for resources to handle the increased volume of patients. Sounds familiar? We knew we would likely be over burdened, and paid little attention, but how’s that so different from the normal state of affairs for public health?
Passing and implementing the new health care act is well beyond noble, and while it may lack in sufficiency, it is necessary. We have to start somewhere, and the plan on the table beats maintaining the status quo, and is well ahead of the alternative. Speaking of which, ask anyone in opposition to the Affordable Care Act for their plan. You will probably get a blank stare and a blank piece of paper, because they don't have one. With that understanding, how bad does it sound to stand on the principal of universal access and what "Obama-care" does to facilitate this goal? I'd say not bad at all, so let's get this done. We've got people waiting to be seen.
PV
