June 20, 2018
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The Obamacare mess

Erik Steele
By Dr. Erik Steele

Many of us who have cared for critically ill patients recognize the point America is at in its health care reform journey; it is the same place critical care teams often end up about two weeks into the care of someone who is critically ill and not improving. Initial optimism about the patient’s prospects has been eroded by the failure of our efforts to turn the patient around quickly, by the overwhelming multiplicity and complexity of the patient’s problems, and by new complications that seem to emerge more quickly than existing problems can be fixed. Some team members are emotionally exhausted, and all are saddened by the possibility that the effort to save a fellow human being, into which we have poured heart and soul, might be for naught. The chorus of voices suggesting that it’s time to let this patient die starts to grow.

In the care of critically ill patients, when that time comes, some team members must resist the infectious fatigue, pessimism and sadness that may lead others to prematurely conclude the patient cannot be saved. That’s where we are with health care reform and the Patient Protection and Affordable Care Act — at the hardest part of the work, when giving up seems easier than fighting on, and some of us have to stand up and say stick to it, we can do this.

So we need to tell our leaders in Washington that we know it’s difficult, messy and painful, but failure to reform the American health care system is not an option. Giving up now when the going has gotten tough, and the tough want to head for the hills, is not an option either. Education, defense, transportation and other parts of the American infrastructure that are all underfunded because we spend too much on health care are counting on us. Our children, our economy, 50 million uninsured Americans, and 26,000 Americans who will die next year because of lack of insurance, are all counting on us.

We all need to understand that the other options for fixing that health care system are messy and difficult, too; if they were not, we would have fixed the system long ago. So failure because Americans hope a simple solution is just down the yellow brick road, they are anxious about reform, the polls about voter support of reform don’t look good, or new problems with the Patient Protection and Affordability Act seem to arise at a much greater rate than current problems get fixed, are no excuse for quitting now.

In fact, they are reasons for doubling down and for renewing efforts to fix problems in the Affordable Care Act. Reform will get more difficult the longer we put it off, options will be fewer, and time to fix the system before national financial disaster will be shorter. If we wait, crisis will guide policy-making. Then the willingness of our leaders to tackle all of that will be less, because if current reform efforts fail, few politicians in their right minds will tackle the issue again for a generation.

This is not to excuse the inexcusable recent failures of implementation of Affordable Care Act. These include the bungled federal health insurance exchange website rollout, and the Obama administration’s failure to keep the president’s promise that those who liked their current health insurance would not be forced to change it by Affordable Care Act. It is to say, however, that abandoning the health care reform “patient” because he did not get better the way we expected, or developed complications we did not anticipate, or because he made it tough on us, is foolish and naïve. This was never going to go perfectly, never going to be free of errors and missteps. We all need to get real and get tough if we are put off by those setbacks.

Critically ill patients, like health care reform, have two ways out of trouble. One way involves a lot of difficult, painful, exhausting, debilitating work. The other way out involves a large bag. Let’s do the darn work.

Erik Steele is the former chief medical officer of Eastern Maine Healthcare Systems. He now works at Summa Health System in Akron, Ohio.


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