When my father started getting sharp, shooting pains in his head and neck last fall, he tried to just tough it out. That's basically how he handles most health problems. It can be a dangerous waiting game to play—the possibility of something serious like cancer or heart disease always looms in my mind—but he has few other options. He doesn't have health insurance.
Luckily, his eventual trip to the emergency room revealed a bad case of shingles and nothing more severe. But with no primary care doctor and no insurance, the emergency room is his only real source of care. Even that he only uses that when absolutely necessary. I remember him seeking medical treatment only a few times in my life, the last being an emergency hernia operation several years ago.
It's not that he doesn't want health insurance. He can't afford it—as a self-employed entrepreneur he was hit early and hard by the downturn. Like millions of Americans, he has had to choose between health insurance and other necessities like food and shelter, and lives one medical emergency away from financial disaster.
Cynicism about healthcare reform comes easy these days, especially after a solid year of hyperbole and bickering. When politicians talk about expanding access to 32 million Americans, most just hear that as another number in a litany of statistics.
But I personally know one of those 32 million whose prospects for real medical care improved with the stroke of President Obama's pen this week, and so does every physician who provides uncompensated care or spends time in an ED.
This is why what happened this week matters and why Vice President Joe Biden emphatically referred to it as a "big . . . deal" (with Biden's own kind of emphasis). Not just because of the opportunities it opens for people like my dad, but also because the next time Denver Health sees him, he will hopefully have better means to pay for care, and even follow-up with primary care physicians and specialists outside of the emergency room.
As long as I have been writing about healthcare, physicians have been sharing with me their frustrations about the number of uninsured in the country. Doctors not only struggle financially because they often provide uncompensated care, but many also are morally uncomfortable with a system that excludes so many people. Expanding access to insurance is important because it will help these patients get the right kind of care, which should be both cheaper and better quality in the long run.
Was the final healthcare reform package all that it could and should have been? Far from it. There is still a lot left undone in the areas of cost and quality, as well as preparing for an influx of newly-insured patients.
But those who aren't simply grinding a political axe will find reasons for optimism even on those fronts. The Medicare payment board opens a path for changing the reimbursement system to reward quality instead of quantity. Several CMS demonstration projects are testing new ways to align hospitals and physicians for better and cheaper care. Investments are being made in HIT, comparative effectiveness research, primary care, and other fundamentals of a strong healthcare system.