A Brief History of Healthcare Reform from the early 1900's to Today

We tend to think of healthcare reform being something new, but in one way or another, it has been an issue since the early 1900's. Healthcare reform has been a bipartisan issue for decades - it is only recently that it has become such a divisive issue.

•       1912-1914 Theodore Roosevelt made the 1^st attempts at healthcare reform; it failed because of WWI and opposition by the labor unions.

•       1933-36 Franklin Roosevelt looked at healthcare reform, but never introduced it in order to save his plan for social security.

•       1946 Harry Truman waged a relentless campaign to enact universal healthcare coverage; it was defeated by opposition from the AMA.

•       1947 Richard Nixon introduced a bill for healthcare coverage

•       1960 John Kennedy and Richard Nixon both endorsed universal healthcare as part of their campaigns for president

•       1965 Lyndon Johnson signed into law Medicare and Medicaid, but not universal healthcare as hoped.

•       1972 An unlikely coalition of Richard Nixon, Ted Kennedy and Wilbur Mills all agreed on the need for universal healthcare coverage. It was stopped by scandal – first Fannie Fox, an exotic dancer linked to Wilbur Mills, then Watergate.

•       1993 Bill and Hillary Clinton took on healthcare reform, but never made it to Congress

• March 23, 2010  Healthcare Reform becomes law with the passage of the Affordable Care Act (ACA)  
  We still have a long way to go - the Affordable Care Act provides access, but does not address all the issues. Only by working together can we make our healthcare system the best it can be - for all Americans.
  

  

Robert Died

The last time I wrote about Robert, he was feeling great and was more optimistic than he had been for months. He was last in the clinic in mid-November. He came in with acute bronchitis. We put him on ten days of antibiotics, filled his maintenance drug prescriptions, and told him we would see him in two months.

In early December, I noticed that we were receiving pages of X-ray reports from the hospital with his name. I briefly looked at them and they were filed in his chart.

Then I saw his obituary. I had no idea, which is fairly common. While we function as a primary care provider in many circumstances, we don’t have a provider here except for clinic nights. Because of that, we usually do not receive any of the communication from the hospital when one of our patients is hospitalized.

What I can piece together is this: he was admitted to the hospital with “cardiac dysrhythmia and treated with anticoagulants and then bleeding began.” What that means is that he was admitted with some type of irregular heartbeat, which they treated with blood thinners – and then he started bleeding. At that time, the testing began and a mass was discovered in his colon (large intestine). The mass was diagnosed as cancer.

One report I received referenced a recent surgery; but, I have no surgery report on him. He had pneumonia or congestive heart failure – I couldn’t really tell from the reports I received. At some point he was on a respirator; he had a feeding tube inserted; he developed an obstruction in his small bowel; he had a central line; there were daily X-ray reports, but no other communication with the clinic. He was ultimately transferred to a regional hospital, where he died.

There are so many holes in the story, but those ultimately do not matter. There was nothing I could do to change the outcome, or to even help. But, I feel so helpless. And frustrated.

We pulled him back from the brink of death last summer, only to have him suffer this much. Was it worth it? Did he have some good days? Some good months? Did he have family that reached out to him?

I am left with questions, questions that cannot be answered. No hospital report is going to tell me what I need to know.

And, maybe the saddest part of all is that he was 55 years old, or rather, only 55.

I don’t know his family, or his friends. I wish I could tell them how much he meant to us, how he always brought a smile to our faces, how much he appreciated us and how he always expressed his appreciation. He always said thank you; he was always polite and happy to see us.

I will miss you, Robert.

Just the Facts

Some fun numbers: there were 2,879 patient visits in 2013 with 245 individuals seeking services for the first time. An average of 60 patients were seen each week – that number is down a tick – we saw an average of 64 in 2012.

The clinic filled 11,727 prescriptions with a retail value of $1,342,708. This is an amazing figure on a budget for medications of $15,000.

The clinic was able to make referrals to specialists in our community for 93 patients – these include surgery, orthopedics, dietician and others. In addition, the clinic has been able to provide the following services on-site: podiatry, ophthalmology and chiropractic with a total of 321 visits to these specialists.

A New Year

A new year inevitably makes us focus on what the future might hold. This year especially causes me to reflect on what the future of free clinics is, and what my role will be in that future.  

The Affordable Care Act was passed in 2010, and honestly, 2014 seemed like a very distant future. But, here it is. The major provisions of the Affordable Care Act are now in place. People can access insurance by going on the healthcare.gov website – and even with all the challenges and difficulties – they are accessing health insurance. It is so exciting to see people who would never have been able to purchase health insurance now able to find a product that is affordable, that does not exclude their pre-existing conditions and will cover all of their healthcare needs.

Yes, I am a Pollyanna – I am excited about the Affordable Care Act and the access it gives to people. But, I am not an idiot. I completely understand that the Affordable Care Act does not address many of the issues we would like to see addressed – such as the rising cost of premiums for those of us who do not qualify for the tax subsidies; the obscene amount of money made by insurance companies; the rising cost of care. But, realistically, we have to start somewhere. And getting people access to care is a great starting place in my opinion.

I firmly believe that we are all better off when we have a healthy community. Healthy people make better workers, better students and better citizens. I cannot think of one reason to deny people access to healthcare.

So, what is the future of free clinics? My crystal ball says… Oh, yeah. I don’t have a crystal ball. So, I have to go with what my gut says. And my gut says the need is not going to go away. People will continue to be uninsured; many will have gaps – deductibles that they can’t afford, co-pays that mean making a decision between eating and taking their medications, and services that just aren’t covered. As for our clinic, the board is having that ongoing discussion. We will see how all of this plays out, see what the needs are, and change or adapt as we need to meet those needs. Our mission has always been to help people. That won’t change. What we do on a daily/weekly basis may change.

One of the programs we are excited about is our Freedom From Smoking group. This is a program designed to help people quit smoking using a group support system. We have been offering this program periodically for the past six months. The next group starts later this month.

We can choose to get bogged down and feel negative about everything, or we can choose to be excited about new possibilities. I think I will err on the side of getting excited. Makes life a lot more fun.

 

First Tuesday

We saw 91 at the clinic this week. It wasn’t a record, but a “near record;” on March 5, 2013, we saw 99. We knew we would be busy – we had been closed for two weeks for the holidays, and then the first Tuesday of the year came with a foot of snow and wind chills in the -20 to -30 degree range. We cancelled for the safety of our patients and volunteers.

What I feel today, after a night like that (other than exhausted!) is grateful. I am so grateful to all the volunteers who give of their time and talent. But, I am especially grateful for the two nurses who called to see if we needed help, and came in unscheduled; I am so grateful to the screeners who responded to my late in the afternoon e-mail that basically said “HELP!”, and they came in and worked, even though they had not planned to; I am grateful to the providers who said, “we didn’t work last week, so we will help out tonight because we know it will be busy.”

Where do you find people like that?? It’s a rhetorical question – I have no idea. God has placed them in my life, and I am grateful.

91 people… without access to healthcare, except in the basement of a church on Tuesday night. And, when we are not here, they have no access.

I never make the decision to close lightly. I know what a burden it creates for those needing our services. My first and foremost consideration is safety. The safety of my volunteers, as well as the safety of our patients.

Today, a big shout out to the best volunteers. Thank you all for all that you do – we could not exist without your generous donation of time and talent.

Care for Caregivers

Henry came into the clinic last week. He is one of my diabetic patients, so I usually know them a little better. And, Henry tends to grumble. He likes to be the “gruff” one. But, he isn’t really.

Anyhow – he came in grumbling about “mother.” Which surprised me, as I had never heard him talk about his mother before. So, I asked him what was going on.

A little background on Henry – he is 62 years old. He spent many years as a truck driver making a really good living. He had money, healthcare, and a home… and then was diagnosed with diabetes. He was unable to pass his DOT exam, so he lost his ability to drive truck, lost his income and healthcare, and eventually, lost his home. When I first met him he was homeless – living in a tent, or during the cold months, in a shed on a friend’s farm.

He started getting disability almost two years ago. In our great system, people who are determined to be disabled are not entitled to Medicare until they have been on disability for two years. (Just an aside: how on Earth does that make sense?? Someone who is disabled/vulnerable – and no healthcare? Our system is broken in so many ways.)

Once he started getting his disability, I knew he was no longer homeless. What I didn’t know is that for the last several months he has been living with and taking care of his elderly mom as she makes the slow, painful decline into dementia.

Like so many of our generation, he finds himself as the caregiver for a parent. The stress is apparent on him – his blood pressure is up, his blood sugar levels are up, his kidney function is compromised… his health is failing. Certainly some of that is due to his own healthcare issues. But as I watch people live with the stress of providing care for a parent with dementia, one of the common threads I see is that their own health and well-being is compromised.

As we debate healthcare and who is entitled to it, let us remember that any of us is one day away from having to take care of a loved one with dementia or other healthcare issues. It is a tough road to walk – and those providing the care need assistance and access to healthcare for themselves.

The Importance of Being.......Vaccinated

I can’t even begin to do this story justice, but this is my attempt.

My 90-year-old aunt wishes that everyone could understand how important vaccines are. She certainly knows.

As we spent the afternoon together, she began to reminisce. Her oldest son, Bill, my second-favorite cousin, was stricken with polio when he was 12 years old. She began the story:

“It was August, and there was a bad summer flu going around. I took him to the doctor, and they gave me some medicine to give him. They said that he probably wouldn’t eat, but to make sure that he drank plenty of fluids. The next morning, I gave him his medicine… and it came back out – his nose! I called the doctor right away, and they told me to bring him over immediately. The doctor took one look at him, and said, ‘I hate to tell you this, but he has polio. Can you get to Ann Arbor right away?’ We went home, and the ambulance came to get him.”

My uncle interjects at this point: “I borrowed a car from my aunt and uncle; all I had was an old car. I had no idea where the hospital was in Ann Arbor, so I stayed right on the tail of the ambulance until we got there.”

My aunt continues the story: “There were no beds available for him when we got there, so he was put in a porch-like area until a bed became available. Once there was a bed available, he was placed in the respirator unit. He was in a bed that rocked; some patients were on respirators, some in iron lungs… it just depended on where the polio affected them. The room was large, with beds all the way around, so that the nurses could see all the beds. There were curtains that could be pulled around the beds.

It was the most awful thing – to see all those people with polio. They didn’t think Bill would be able to walk. When the doctor took braces in to put on his legs, he told them he was not going to wear those. He told me that he had walked around the bed, and he was going to walk. He never did wear the braces.

After a little more than a month, we took him home. They taught me how to do his exercises and take care of him. If he started to choke, I would suction his throat.

Every day we would spend time doing his exercises, usually with both of us in tears before we were done.”

As she told the story, both of us were in tears. Bill is a big marshmallow of a man. He is probably 6’8” – one of the tallest men I know. I wasn’t born yet when he suffered from polio, so I only remember him healthy and well.

But, like many polio sufferers, he recovered, but today suffers from post-polio syndrome. He never has a day that is pain-free or easy. Bill’s stubbornness allowed him to overcome the effects of polio as a child. He has lived a full, busy life – he has never been “disabled” in any way.

My aunt’s frustration is that there are so many people today who are not vaccinating their children. Medical science came out with a vaccine less than a year after Bill contracted polio. She is thrilled that no one today should ever have to suffer as they did.

But, the vaccine won’t work if it’s not given; and, this is an epidemic we don't ever want to see again.

Happy New Year – 2014 is finally here!

The clinic has been serving as a Certified Application Counselor designated organization for several weeks now. Connie and I have worked with a number of individuals and families. It is so exciting to be able to help them purchase healthcare coverage for the first time in years. It is affordable, comprehensive, and there are no questions asked about their health status. So, people with diabetes, heart disease, and high blood pressure are able to buy healthcare coverage.

With the tax subsidies available, some have had premiums of $0. These tax subsidies are ONLY available to people with some income – so these are working individuals, who make so little that they are barely able to put food on their table. They now have healthcare coverage. That means if they end up in the hospital, they won’t have to file bankruptcy. It is huge.

The premiums have ranged from $0 to $125 for a family of two for the people I have worked with; Connie has seen about the same range.

Many of the clients from the clinic will qualify for the Medicaid expansion once that is in place in Michigan. Because our legislators did not act in the best interest of the people of the state of Michigan, this expansion will not take place until probably April.

But, we are excited to see people enrolled in healthcare coverage that will be real and meaningful in their lives. No one should have to go through life without healthcare coverage.

So, 2014 will be filled with challenges and with changes. We will be here to help individuals and families find their way through the maze.

Happy New Year!