Healthcare Secrets

How do Americans talk about our health? We’ve come a long way from the days when we whispered about Aunt Suzie going into the hospital because of “female problems.” HIPAA regulations may protect a patient’s right to privacy regarding medical records, but many people do speak quite openly about their health, articulating specific prayer requests, posting comments and photos to social media, and even giving “organ recitals” when asked, eliciting my response: TMI (too much information).

How I wish “TMI” was the problem with the life-and-death healthcare decisions being made in Washington, D.C. these days. Instead, we’re caught in a bubble of TLI – too little information. If the American Health Care Act (Trumpcare) passes as approved by the House, what will it mean to us? And how much will it cost?

We ask these questions regarding most life decisions, including medical care. Thinking about a knee replacement or a tummy tuck? The questions are simple: what will it do for me, what are the risks, and how much will it cost? I might look a bit better on the beach this summer with some help from the plastic surgeon, but at the cost of considerable pain and a $6000 out-of-pocket payment? Nah, not worth it to me. But when a knee replacement offers a new lease on life, a $2000 out-of-pocket fee sounds like a worthwhile investment.

Is it too much to ask our elected representatives to reveal the details as they determine the affordability and accessibility of medical care for millions of Americans? Shouldn’t those serving us in the House of Representatives and the Senate articulate the benefits and risks to Americans, and know how much the American Health Care Act will cost in both money and lives before voting for the bill, not after?

Why the secrets? David Leonhardt offers his take on the secrecy: “The effort to take health insurance from the middle class and poor and funnel the savings into tax cuts for the rich is a little like mold. It grows best in the dark. That’s why Republican leaders in the House handled their bill as they did. They did not hold a single hearing, because they knew that attention would have been devastating.” Is he right?

But the “other side” did it this way too, didn’t they? I’ve heard that comment often, so I looked at what happened when the Affordable Care Act (Obamacare) was passed in 2009. The New York Times reported, “In June and July 2009, with Democrats in charge, the Senate health committee spent nearly sixty hours over thirteen days marking up the bill that became the Affordable Care Act. That September and October, the Senate Finance Committee worked on the legislation for eight days – its longest markup in two decades. It considered more than 130 amendments and held seventy-nine roll-call votes. The full Senate debated the health care bill for twenty-five straight days before passing it on Dec. 24, 2009.”

Is it time to lift the veil, to release details and hold senate hearings? Insurers are concerned, as Catherine Rampsell of the Washington Post reports: “Will there still be an individual mandate? Will the Trump administration continue reimbursing insurers for the discounts they are legally required to give to poor people? Will there be huge cuts to Medicaid?” And our own questions. “If my neighbor with cancer loses her job at sixty, will she be able to afford insurance? How much will it cost to have a baby (asking for a friend)? Will my adult son have to live without insurance again?”

Here’s my plea to Congress. Ditch the secrets. Schedule hearings. Let the people of America hear and speak. If we can handle the details of Aunt Suzie’s female problems, we can handle the details of the AHCA. President John Fitzgerald Kennedy knew this about us: “We are not afraid to entrust the American people with unpleasant facts, foreign ideas, alien philosophies, and competitive values. For a nation that is afraid to let its people judge the truth and falsehood in an open market is a nation that is afraid of its people.” It’s time Washington remembers who Americans really are.