Health care reform is good, but some pieces are missing

By Janet Stevens / The Bulletin

Admittedly, Bob Dickes has a stake in how well the Affordable Care Act — Obamacare — works. He’s director of marketing for Oregon’s Health Co-op, one of two cooperative health insurance groups that soon will provide coverage to their members in the same way that other cooperatives provide goods or services to members. Yet when Dickes talks about the ACA, it’s clear he wants it to work, and he makes a good case for why it should.

Do his views change my mind about the ACA? Certainly not completely. I continue to worry that the law will prove hideously expensive in ways we have been unwilling to discuss, for one thing. I have other reservations, as well. At the same time, Dickes’ view is a different look at the problem than I’ve heard, and I believe it is worth sharing.

Dickes, who has been in the group insurance business for 29 years, describes the ACA not as a new way of providing health care in this country, but rather as nationwide insurance reform. It may not be all the health care reforms this country needs, but it’s a good start and about to get better.

Dickes notes that the ACA already has had an impact on millions of families in this country: Parents can keep their children under the age of 26 on their insurance policies, for one thing. And, insurance companies can no longer refuse coverage to people up to the age of 18 if they have pre-existing conditions. Starting next year, that latter rule will apply to people of all ages.

Moreover, he says, the law makes it far more difficult for an insurance company to rescind your policy in the face of an expensive illness. Companies often did just that, he says, by arguing you had somehow committed fraud on your application — by failing to answer every question, for example.

Put together, those changes will make it far more difficult for insurance providers to cherry-pick the best customers, the healthy young men and women whose health care costs are most likely to be low.

There are other reforms, as well, Dickes says. All health care policies written after March 23, 2010, are required to provide a surprisingly comprehensive list of services free, everything from blood-pressure screening to immunizations for adults and children to removing annual or lifelong caps on what a company will pay The goal, he says, is to assure that skimpy health insurance does not keep people away from the treatments they really need.

Still, insurance reform is not the only change needed to the American health care system, Dickes believes.

He notes that Americans spend more per capita on health care than anyone else in the world. Yet, according to The Atlantic, our death rates are higher than at least 16 other countries. More of our children die under the age of 5 than in any of the other 16, and more women die in childbirth or as the result of pregnancy complications. We have the second highest rate of heart and lung diseases, and the highest teen pregnancy rate.

So what’s wrong? For one thing, Dickes says, Americans are impatient. We get sick; we want to get well, and do so now, no matter what the cost. We don’t take good care of ourselves; our obesity rates are high and our exercise rates, low. If it comes down to taking a pill or changing a lifestyle, too many of us opt for the pill.

Moreover, Dickes says, we don’t link the cost of care to performance — mediocre doctors make just as much money as good ones. Nor have we gotten a grip on either the drug or medical technology industries. Newer is always better and often more expensive, though, in the case of drugs, at least, newer may be as simple as a repackaging of the old.

Changes to the system aside, it’s clear Dickes believes that unless Americans are willing to take a good hard look at themselves and the way they live, the kind of reform that actually improves health and saves money may escape us. We must walk more and eat less, clearly. We must ask our doctors if an MRI, for example, is really necessary or if a shoulder injury can be fixed with physical therapy rather than surgery. We must recognize, too, that people grow old and they die. That’s life, and there’s no escaping it no matter how much we spend at the end.