There was a time when I would've considered the ACA unnecessary. That I would've been annoyed by it. This was also a time where I had little to no interest in politics. It's funny how life has a way of humbling a person and teaching them something new about themselves on a regular basis. This is a story about how I ended up needing the help in order to make myself better.
"Well why didn't you just get a new inhaler?" I felt a sinking pit in my stomach. I was at a follow up visit to my doctor after ending up in the ER a few weeks before because bronchitis had made my asthma worse and I couldn't breathe. The first thing my doctor asked me was where my inhaler was when this had happened. After all, that was in my plan. I tried to explain to her that I only had one inhaler and it had been stolen the week before when I was riding the bus. Somehow, despite my explanation she didn't understand that since I was uninsured at the time, I just couldn't afford a new one. It was only after the ER trip that a friend of mine had pity on me and bought the inhaler for me.
I lost my insurance in April 2012 because I had been working at a call center that had outsourced its customer service department overseas. This was my fourth lay off in about six years. The whole time I had been trying to go back to school but in playing musical jobs I had never managed to do so. I decided to make school my focus and work secondary and deal with it.
Because I have asthma, I've never been able to get insurance without going through my work before. COBRA would've cost me over six hundred a month, and while my state had opened a high risk pool, it was still too expensive. My NP was awesome and made sure I got refills of my medication before I lost my insurance and gave me a list of community services for when I did lose it, because she knew I wouldn't be able to come back afterwards.
I did everything I could to make sure I would be taken care of. I signed up for a prescription plan at a local pharmacy, I found local clinic that was free, run on community donations. Still there are things that free clinics couldn't handle. Waiting all week to see a doctor because you got sick on Sunday and the free clinic is only open on Saturday isn't helpful when you're so sick you can't breathe. The doctors are volunteers so there's no guarantee of continuous care. In fact, the push is to get you into a local public health or community clinic, but they often were not taking new adult patients or were an hour drive away.
It was about a month after I lost my insurance when I found a lump on my right side, along the edge of the breast tissue. The free clinic provided me a referral but when I called the places they suggested I was turned away. I was told I was too young, that the office no longer provided services, or that they were out of funds for the year. I continued to fight to find a way to access services, but without a referral from a PCP I was getting nowhere. I finally took the time to bus out to one of the few clinics taking patients. They contacted a local imaging center attached to a public hospital to get me in. This started in June, I was finally in for imaging in October. In November I would get a biopsy and find out it was benign. It took me six months from start to finish to find out what was there.
It would be another year before I would get insurance again. In that time I ended up in the ER enough times the doctors started to recognize me. There really wasn't anything either of us could do. I couldn't manage my health without being able to afford regular doctor's visits and medication and they couldn't make a solution appear out of thin air. My wisdom teeth got infected and had to be removed but had to wait two months for a dentist who would help. I was on antibiotics so long I ended up with a GI infection. Bronchitis, allergic reaction, a set of second degree burns from how bad at cooking I can be. They got to deal with it all, despite the fact that most of these things were preventable.
All if this changed in January of last year. I live in one of the states that approved the Medicaid expansion and set up their own healthcare exchange. I was there on day one to shake hands with the Governor, tell him my story, and sign up. I stood up with him to others to encourage them to use the exchange as well. It is the only day of class I've missed since I started back.
Because of the Affordable Care Act I was able to get needed blood work that I had not been able to afford. Reliable access to medication. The first thing my PCP did, remembering how just a few months earlier I had ended up in the ER because I didn't have an inhaler was make sure to get me a prescription for one so I had a backup. One thing I know is I appreciate the opportunity more than I could ever express.
I know there are naysayers out there who will tell me that those things are not really free and that someone has to pay for them. One day I'll graduate and that person will be me. I seriously hope that I am paying to make sure someone gets the care they need with the money I pay into the system. It's saner than paying for what happens when they can't. The system we have isn't perfect, but it can only get better if we put effort into it.
America's "most vulnerable" have a roof over their head, eat everyday, own cell phones and flat screen televisions. You don't know what real poverty is. Real poverty occurs in other countries.
Are you actually suggesting that there is no such thing as poverty in the US?!?! What do we have here if not "real" poverty? It's just pretend? Seriously........
Are you actually suggesting that there is no such thing as poverty in the US?!?! What do we have here if not "real" poverty? It's just pretend? Seriously........
It's not that hard to understand what I wrote. Poor people in the USA are rich compared to poor people in other countries. Poor Americans are obese. Poor people in other countries are LITERALLY starving.
Oh ye gads. More of the "if we allow universal healthcare all rich people will be poor because all their money will be taken to pay for the poor peoples healthcare" uninformed and completely untrue hysteria.
(and that is the nicest possible description I can find for this uninformed untrue hysteria)
Our system works. People arent denied needed healthcare because they dont have insurance or because their insurance company is looking for every possible loophole to get out of paying the bill
As a nurse, I'm in the second highest income bracket in my country. I pay tax as does every other NZ citizen. I dont have to pay extras to pay for poor people. My sister who is the emergency doctor (in the highest part of the highest income bracket) and she doesnt have to pay for extras either
Someone who is unemployed can get income support while they are looking for work. If someone is injured or becomes unable to work due to illness or injury can also get income support while they recover.
Our system works. As far as I am concerned the ACA doesnt go nearly far enough, but its a good start.
Shortly before Christmas, I became really unwell with an abcess that festered and I became septic. I was in hospital for six days. I had QID IVABs, 2 ultrasounds, surgery to incise and drain the abcess, as well as regular wound care. I also had follow up wound care at home because of the location of the wound, (under my arm) meant I couldn't dress it myself. The total cost? About $12 for the antibiotics I needed on discharge.
I dont feel remotely bad that the tax payer carried the cost for that. Its what the system is set up for. To provide healthcare and assistance when people need it
Yet another liberal who is disappointed with Obamacare.
Yes, deeply disappointed. The whole mess is because the Dems in Congress made a futile effort to get congressional Repugs on board by constructing a plan that includes every item on the GOP healthcare wish list. Then, after they created a deeply flawed plan in an attempt to be bipartisan and collegial, the Repugs all refused to vote on a bill that included everything they had been promoting as the "answer" to healthcare reform all these years.
We would be much better of if the Dems had just recognized that the Repugs would tear out their tongues with pliers before they would vote for any kind of healthcare reform proposed by the Dems, even reform that was what the Repugs had said they were in favor of for years, and just passed a single-payer system plan (or, at least, a plan that included a "public option," an idea which was wildly popular with the public at the time) while they had the chance.
New Zealand's health-care system is undergoing a series of cutbacks to reduce costs, but critics are concerned that the health of people on low incomes and in some population groups may suffer. Rebecca Lancashire reports in our series on health financing.
When Robyn Pope was diagnosed with breast cancer in 2008 she was told that she would have to wait two months for a mastectomy if she wanted breast reconstruction as part of her treatment in the public health system. Two months may not seem like a long time,†says Pope, a mother of three, who lives on the Kapiti Coast of New Zealand, but a day lived knowing that you have cancer in your body is like an eternityâ€.
The underlying reason for the delay was a familiar one – funding. Like other countries offering universal health care, New Zealand struggles to meet the steadily growing demand for a full range of high-quality health services offered largely for free to everyone, while remaining cost efficient. In the past eight years, New Zealand's total health expenditure has doubled to 3.6 billion New Zealand dollars (NZ$) (US$ 10 billion). In the face of economic slow down, the government is calling for reform to rein in this expenditure.
Jules Taniwha and Justine Thorpe of Well Health primary health organization.Rebecca LancashireJules Taniwha and Justine Thorpe of Well Health primary health organization.
High-income countries with ageing populations need to look for efficiencies in their health systems,†says Riku Elovainio, a health economist at the World Health Organization. But the pursuit of efficiency should not result in deterioration of the system's quality nor in its equity. Governments that make cuts to primary health care services usually regret this decision, as it can end up costing more in the long run.â€
While Pope was unhappy about the two-month wait, she says that her primary health care providers – particularly the community oncology nurses – were fantastic†and her entire treatment was free. Relief for other patients is now in sight. Reducing waiting times for critical cancer treatment, in particular radiation waiting times, is one of the government's health targets to be achieved by the end of 2011.
Some health services, such as those offering cancer treatment, may receive more funding under government plans to improve quality and efficiency, while others face cuts. But the cuts, critics say, mean that fewer services may be available to some population groups and doctors' fees remain prohibitively expensive for some people.
The public system in New Zealand is generally quite good and deals well with serious illness,†says Don Matheson, Professor of Health Policy at Massey University, Wellington, and a former Deputy Director-General, Public Health, for the Ministry of Health. Its patient-centred system and well-coordinated care are seen as exemplary by other countries, he adds. But, he says, equity is a glaring problemâ€. When significant numbers of New Zealanders cannot afford to go to the doctor, this creates a knock-on effect through the system – they won't access care and their health outcomes will be worseâ€.
While the majority of public services are provided free to patients, including almost all public hospital treatment, care during pregnancy and birth, and basic dental care for children, most New Zealanders can expect to pay between NZ$ 17 and NZ$ 75 per visit to the general practitioner. Visits to doctors are free for most children aged less than six years and cost less than NZ$ 20 for very low-income earners. According to the Commonwealth Fund's 2010 survey of world health systems, 32% of low-income earners in New Zealand said they did not visit a doctor in 2009 due to the fees.
Most of the country's primary health care services are organized by Primary Health Organizations (PHOs) – with services provided by groupings of doctors, nurses, counsellors and other health professionals – that provide a wide range of first-line curative and preventive health services and serve more than four million people, some 95% of the population. As part of its reform, the government plans to halve the number of PHOs through mergers and closures. So far, the original 81 PHOS that were established since 2002 have been reduced to 70.
Don Matheson, Professor of Health Policy at Massey University, Wellington. Courtesy of Don MathesonDon Matheson, Professor of Health Policy at Massey University, Wellington.
The country's health delivery model is in flux but is currently made up of 20 District Health Boards (DHBs) located throughout the country, funded by the Ministry. The DHBs plan, fund and deliver most publically funded health services, including hospitals. In 2009/2010, DHBs incurred a deficit of almost NZ$ 100 million.
Both DHBs and PHOs are facing cuts to their budgets. How these and any further cuts will affect New Zealanders' health is difficult to gauge in the short term. At the moment, the health of New Zealanders is in good shape, according to Deborah Roche, the Ministry of Health's Deputy Director-General, Strategy and System Performance. Roche points to the 2008 and 2009 figures which show life expectancy and infant survival have increased markedly since 2000. The past three years have also seen a steady increase in immunization and decline in smoking.
Despite these improvements Maori, who constitute 14.5% of New Zealand's 4.3 million population, and Pacific people (6.9%) both have disproportionately poor health outcomes compared with the rest of the population. These include high rates of chronic diseases, such as diabetes and heart disease, and childhood illnesses such as rheumatic fever, which is linked to poor living conditions such as damp, overcrowded homes and poor nutrition.
It's not about the number of PHOs – it's about PHOs being capable and fit for purpose to address these issues across populations at a local level,†says Roche, pointing out that around one third of New Zealanders are enrolled in just four PHOs, while 12% of the population is spread thinly across 41 smaller ones, which struggle to achieve efficiencies of scale and the integration of services across the system.
Many smaller PHOs facing merger or closure argue that their services are already highly efficient. The key role of the PHO is to get to know the community and you can't do that if you're too big,†says Justine Thorpe, co-manager of the Well Health PHO in New Zealand's capital city, Wellington.
Jackie Cumming, associate professor and director of the Health Services Research Centre at Victoria University, Wellington, shares Thorpe's view: Smaller PHOs can be really effective and help reduce inequalities by working very closely with the community and health professionals to ensure those services are actually working,†she says, adding that there has not been enough analysis of the effectiveness of individual PHOs to know whether mergers are a good idea.
Deborah Roche, Deputy Director-General, Strategy and System Performance, at the New Zealand Ministry of Health.New Zealand Ministry of HealthDeborah Roche, Deputy Director-General, Strategy and System Performance, at the New Zealand Ministry of Health.
Neither is size necessarily an indication of impact, Thorpe says, pointing out that some smaller PHOs, such as Well Health's two branches serving low-income communities in Newtown and Porirua, deal with high numbers of clients with several chronic diseases. Says Thorpe: Well Health may have just over 13 000 clients but it is a high-needs population. We have 20% refugees and migrants and 35% Pacific Island, 19% Maori and the rest European.†A high percentage of this population requires services for mental health and diabetes.
Thorpe is wary of a deficit reduction policy that, in her view, simply throws up a financial barrier to access. Thorpe says that government pressure on DHBs to reduce their deficits straight away puts a huge pressure on usâ€. We can't put [those costs] onto our clients. Many can't afford to pay, and yet they are the ones who most need these servicesâ€.
Jules Taniwha, who has diabetes and respiratory illness, is a patient with Well Health's Newtown Union Health Service and an advocate for several local community health groups. She is also concerned that funding cuts may mean PHOs are forced to raise their fees. We Maori are living longer in the past 10 years but I am worried now that we might go backwards,†she says.
Matheson says equity is not a problem that can be solved simply by making the system more cost effective. We can make the system more efficient by providing more operations for this particular dollar or more consultations for that,†he says, but the question is who actually gets those extra services and are they the people who need them most?
Yes, deeply disappointed. The whole mess is because the Dems in Congress made a futile effort to get congressional Repugs on board by constructing a plan that includes every item on the GOP healthcare wish list. Then, after they created a deeply flawed plan in an attempt to be bipartisan and collegial, the Repugs all refused to vote on a bill that included everything they had been promoting as the "answer" to healthcare reform all these years.
We would be much better of if the Dems had just recognized that the Repugs would tear out their tongues with pliers before they would vote for any kind of healthcare reform proposed by the Dems, even reform that was what the Repugs had said they were in favor of for years, and just passed a single-payer system plan (or, at least, a plan that included a "public option," an idea which was wildly popular with the public at the time) while they had the chance.
"Repugs" is name calling, but somehow I doubt you will receive a warning. Anyway, thank you for admitting that Obamacare sucks.
Specializes in NICU, PICU, Transport, L&D, Hospice.
One has always been able to buy their own insurance from companies such as BCBS. It isn't like you are required to find a job before you can get insurance.
Yup
very familiar with those policies.
Have you ever heard the stories about people who had "insurance" only to have it cancelled when they got sick and needed it? Yeah...those are the policies that did that. I personally know and care about people who found themselves with health needs and without insurance when things got tough. Everyone of them experienced financial devastation at the same time they were trying to save their lives and preserve their employment while their health insurer kicked them to the curb. One couple ultimately lost their home and all of their retirement savings but managed not to file bankrupcy, they are in their late 50s and 60s now and will depend upon SS when they are no longer able to work now.
Yup, those insurance policies were a great "bargain" or "deal"...unless you actually needed care.
Specializes in Mental Health, Gerontology, Palliative.
In other words, you approve of forcing rich people to pay your bills.
Nope. As for being poor. I'm in the second to top highest income bracket and I pay more taxes because I got off my orifice went out and got a degree that vastly improved my earning potential.
I'd try and explain it however so far, you've shown you tend to reject anything that doesnt correlate with your world view and I dont have the time this morning
One thing I've found about americans who dislike the idea of the ACA. Is they would much rather believe the hysterical propaganda fed to them by republican politcans about universal healthcare and other such incarnations than take time actually listen to people who have actually experienced these systems.
Turtles2
135 Posts
Now you are changing the subject. Do you admit the babies would not had died?