A Glimpse into the US Healthcare System by Elizabeth Pope

Guest post Elizabeth Pope Twitter @popesbeats Blog Popesbeats

How this idea started about writing this blog....

One of the organizers of the wow petition asked me to provide a perspective on the US Health care system. Prior to that, Since last summer, I started providing technical assistance to a wonderful group of United Kingdom Disability Rights Advocates. They were getting ready to organize around their country and communities on the benefits, welfare and rights of people with disabilities. On twitter, they use the hashtag #WOWpetition. It is a petition surrounding the benefits of people with disabilities in the UK. It has since grown to around 37,000 signatures. There hope is to reach 100,000 so it can go forth into the British Parliament and become a legislative priority. They are moving forward at lightning speed. I am so proud of their hard work and dedication!

Background Information

Since becoming a Community Organizer and overseeing many issues affecting people with disabilities,  I've applied a lot of experiences. I cover two counties right now: Monterey and Santa Cruz. San Benito is a work in progress.

 In a span of four months, I am continuing to learn more about Affordable Care Act by just sitting in on many meetings related to public health care and access to care. I sit on an Access to Care Steering Committee, which is trying to figure out how to implement the Affordable Care Act with the county's support and other stakeholders. It has been an interesting time. I have sat in the Safety Net Integration Council meetings with several different entities.  There is also another piece to this called 'Covered California.' Here is the website.


There is an article on the  Monterey Herald's website about our public hospital Natividad having a meeting with a consultant group. They advised them that they could benefit from partnering with another hospital. This strategic plan will cost  $180,000 dollars and will be completed in 4-6 weeks. They spent taxpayers money on a consulting firm. Really baffled by this.

Next, is the Dual Eligibles. Medi-cal and Medi-care. For example, when you are applying for Social Security, you would qualify for Medi-Cal and the Supplemental D portion if you are over the age of 55 or 65. For those who work in public benefits counseling, They would understand this area a lot more.

This is known as Managed Care. There is a campaign going on in our SC Net statewide network called "Making Managed Care Care". For more information about this, please refer to the www.scnetca.org. That's the SC Net otherwise known as the Systems Change Network. That is what I belong too. It is a collaborative group of Advocates all over California who work on local advocacy work in their counties and on statewide campaigns.

The other area of health care is the PPO's and HMO's. That would be Kaiser and Health Net. PPO's would be Blue Shield or some other health care provider.

In Home Supportive Services is a program in different areas of the United States. It is within the Department of Social Services government agency.

 This is where an individual who needs assistance in the home can get it through a caregiver. Someone who cooks, cleans, transfers, helps then bath, shower, drives them to doctor's appointments, etc. I almost was hired a few times, but did not have the necessary paperwork in and or fingerprints.

I do hope that this background information is helpful and informative. It provides a clear picture into what health care is.

Here is my take on the health care perspective in the United States...

A Glimpse into The United States Health care System

Throughout the United States, many residents, public and state officials are preparing to implement the Affordable Care Act. It takes into effective on January 1, 2014. This will make affordable coverage to all legal residents of the United States. The positive outcomes of the Affordable Care Act are in progress. From moderating health care costs to improved health insurance.

Currently, tens of millions of Americans are benefiting from the law through

provisions that do things such as allow young adults to stay on their parents’ health plans,
seniors paying less for prescription drugs and preventative services, mandatory coverage for
children with pre-existing conditions, and eliminating lifetime caps on insurance plans,
especially for those with expensive illnesses.

The United States is experiencing an unprecedented slowing of health care cost continues increasing. In 2012 marked the fourth consecutive year of record-low growth compared to all previous years of health care spending. However, there are recognizes current problems that need to be addressed regarding the Affordable Care Act, including states denying federal Medicaid funds and looming budget cuts. States that refuse these Medicaid expansion are denying health care to millions to the most vulnerable populations.

 Funding for vital health care programs is also in danger as sequestration, or acrossthe-board automatic spending cuts, are scheduled to occur on March 1, 2013.

Recommendations to Make the Health System More Effective:

 Renew commitment at both national and state levels to effectively implement the
coverage expansion under ACA, particularly ensuring the poorest and most vulnerable
have access to affordable coverage.
 Reach agreement in Congress and in the Administration on a plan to replace
sequestration cuts and prevent future disruptions in funding for critical health care, by
enacting fiscally- and socially- responsible alternatives to reduce unnecessary health
care spending.
 Eliminate Medicare’s Sustainable Growth Rate formula and support a transition to new payment models.
 Implement policies to recruit and retain primary-care physicians.
 Reduce firearms-related injuries and deaths by improving access to mental health
services, supporting research on the causes and prevention of violence, and enacting
reasonable controls over access to firearms that do not infringe on constitutionally
protected rights.
Recommendations to Reduce Intrusions on the Patient-Physician Relationship:
Payment reforms must allow physicians to spend more appropriate clinical time with
their patients.
 Payment and delivery reforms that hold physicians accountable for the outcomes of
care should eliminate the layers of review and second-guessing of clinical decisions
made by physicians.
 Center for Medi-care and Medicad Services should harmonize the measures used in different reporting program.
 Center for Medicare and Medicaid Services should provide more clinically relevant ways to satisfy the requirement that
physicians must transition to using ICD-10 codes for billing and reporting purposes.
 Congress and Center for Medicare and Medicaid Services should encourage participation in quality reporting programs by
reducing administrative barriers, improving bonuses, and broadening hardship
 The government, the medical profession, and standard-setting organizations should
work with Emergency Hospital Room vendors to improve the functional capabilities of their systems.
 Medicare and private insurers should move toward standardizing claims administration
requirements, pre-authorization, and other administrative simplification requirements.
Congress should enact meaningful medical liability reforms including health courts,
early disclosure of errors, and caps on non-economic damages.
State and federal authorities should avoid enactment of mandates that interfere with
physicians’ free speech and the patient-physician relationship.
The above bullet points are some key points that are related to the Affordable Care Act.  It continues everyday coming out with more new information. It is a never ending cycle.

Congress is one of the legislative bodies in our United State Governments. They make the sole decisions on various different federal bills and legislation. In my viewpoint, I feel like they are not doing a good enough job of figuring out how to implement the Affordable Care Act. For example, how much will it cost? How much will people have to pay? Is it really going to cover everyone? Those are some questions to consider. There may not be enough leverage or weight to it.

For example, Monterey County(which has cities such as Monterey, Salinas, Carmel, etc) has implemented the Low-Income Health Program(Via-Care). This was a two-year battle. Could not believe it took them that long to do it. Major credit to Jane Parker and Simon Salinas our county board of supervisors for leading the way to get this implemented.

 This is a temporary program until the Affordable Care Act is fully implemented. Not sure of the current enrollment numbers. They have exceeded the amount allocated. I've been inside Natividad. It is a nice facility. This is the public hospital that provides care. However, people have suggested it should partner with another hospital to provide full health care. It would be a great idea.

Participated in larger coalition groups, other issues related to health care. It is not accessible or affordable. South County is the most under served population of low-income families, people with disabilities who cannot afford transportation to access these services. There are barriers. What can we do?

Trying to figure that part out. Add in the recent sequestration cuts. In fact, I am going to a summit this week on that very subject.

For more information about... Read these articles. They give a pretty good overview of what I am specifically talking about.



Final Thoughts/People with Disabilities Perspective

Through learning the in's and outs of the Affordable Care Act, Covered California and many more programs, I feel like I will have to re-learn everything again, once more information becomes available. Health care is a complex issue. That's the way it has always been. People with disabilities perspective is that nothing is affordable to the community. The cost of rising health care is becoming too expensive.

If there was a way to reduce the costs from the insurance companies, that would be ideal. For now, we are continuing to pay out of our own pockets as prices continue to skyrocket. Lots of advocacy going on around the country. Let's work together to make health care affordable not only in the United States, but around the world.

1 comment:

  1. one example of gaps in the system if you are single and 19 to 64 and you make over the $900 allowed you do not qualify..So if you make 1,100. now you can afford health care. Same with a couple a few dollars over the low-income level you now can afford health care..I believe it leave a big gap.