Supreme Court Ruling Offers a Sense of Hope
This post is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Thomas Tsang, MD, FACP, is a former Senior Advisor to the Governor, State of Hawaii and alumnus of the RWJF Health Policy Fellows program.
Last week, the Supreme Court upheld the Affordable Care Act (ACA) and ruled that the individual mandate is constitutional. As I reflect upon the positive impact of the Supreme Court decision on the tens of millions of Americans who are uninsured and have no access to affordable care, I reflect also on how my own family could have benefitted from legislation like this two decades ago and how my parents’ health status may be different.
We were the classic immigrant story. We emigrated from Hong Kong in the early 70s with the notion that things would be better in America. My father worked 14-hour days, six days a week as a cook at a Chinese restaurant in suburban New Jersey. The eight of us had no health insurance for close to 20 years. My family did not qualify for Medicaid, and paid for medicines and doctor visits as needed.
Things were fine until my parents reached their late 50s. They were diagnosed with one chronic disease after another because signs and symptoms had appeared that forced them to seek medical attention. First, it was hypertension, then diabetes, then heart disease and ultimately renal disease. We were fortunate that none of us had a life-threatening condition that required acute hospitalizations when we did not have coverage. By the time my parents qualified for Medicare, they each had accumulated at least three chronic conditions and were taking at least six or seven medicines.
Aside from paying for their own medical problems, they needed to pay for the medical care for their six children—visits for dental care, vaccinations, strep throats, food poisoning, high fevers plus the occasional antibiotic shots that my mom requested each time from the pediatrician. My parents had neglected their own medical needs at times in exchange for housing, food and clothes for the eight of us.
I wonder, what if they had access to basic primary preventative services, screenings or physicals when they were 40s or 50s? What if they had subsidies and if their employers had access to affordable plans in a health insurance exchange? Maybe their diabetes and hypertension could have been controlled enough to prevent the nephropathy or the congestive heart failure?
The restaurant where my father and brother worked simply did not make the margins to afford health insurance for their employees. They operated on margins of three to five percent at best. Similarly, my sister who worked in a sewing factory in Chinatown had no insurance until she switched to a manufacturing-job in the suburbs of Philadelphia in her late 50s. Like our parents, she entered the Medicare program with at least two chronic illnesses and four medicines.
The last four years, I worked on the health care reform legislation on the congressional level, implemented parts of it as part of the Department of Health and Human Services and most recently worked on a health care transformation agenda for the State of Hawaii. I am astounded at the how penny-wise and pound-foolish opponents of the Affordable Care Act have been. A study conducted by the Commonwealth Fund in 2009 concluded that the uninsured cost Medicare an average of $1,000 per beneficiary, because they have higher rates of heart disease, diabetes and joint problems compared to those with insurance.
The cost of our health care system is now $2.9 trillion, and close to 18 percent of our Gross Domestic Product. It is unsustainable for American businesses including many of the small businesses such as the ones my father and sister worked in.
The Affordable Care Act offers a glide-path for the delivery system. It pivots us to a path of rehabilitation that will give 30 million Americans access to basic benefits offered in insurance exchanges with tax subsidies. The delivery system innovations such as Accountable Care Organizations supported by holistic payment policies would move us away from the fee-for-service treadmill, improve on quality and likely trigger new innovations for greater efficiency and value.
As the law is implemented over the coming months, the framework of Meaningful Use (from the HITECH Act of 2009) is put in place, and patient-centered delivery system redesigns spread, I feel a sense of hope and order that things will be on the mend. The ACA is far from perfect, but now the country can start healing together and work on finding better solutions for future generations who believe that life is indeed better here in America—as my parents and I still do.