The Sweet Spot of Health Care Reform

  • Chow, Harrison, MD
| Jun 18, 2012

sweet spot (noun)

Definition - best place for hitting a ball: the most effective place to hit the ball on a racket, bat, club, or other piece of sports equipment — Encarta Encyclopedia

Anybody who plays sports, particularly ball or racquet sports knows about the "sweet spot," the place of mysteriously successful physics, where ball meets racquet or golf club in almost perfect harmony of all components. It is an elusive place for most aging, amateur weekend athletes such as myself, but I know it when it happens.

Likewise for health care reform, the sweet spot for any substantial reform efforts remain elusive. Year after year, we hack away with legal, political, moral, religious and economic flails. Simplistic bromides like "health care is a right" and "single payer" just result in figurative head banging. After enduring two decades of calls by questionably informed pundits to rally around a myriad of “solutions,” my ears are numb…

Since looking at a global perspective fails to provide clarity, let’s focus on a single case-in-point: Just one patient. “Maria,” who celebrated her 65th birthday in a novel way—she went to see a doctor for the first time in a couple of years. One week later she was on the operating table at my hospital undergoing a radical mastectomy for hopelessly advanced breast cancer. Three months later, Maria was dead.

A little poking around into her background provided context for her personal tragedy. Maria had worked with custodial staff, as a janitor, all her life. From her last job at a local Fortune 500 software company, Maria was laid off as a 63-year-old during the economic downturn. Struggling with a mortgage, the always-healthy Maria went without health insurance doing the "Medicare stretch," using hope and denial in lieu of medical care, until she reached the magic age of 65.

The center of her family's life, Maria kept busy working cleaning jobs and keeping her own house, preserving the big family gatherings. During all of this she ignored a lump in right breast, which grew larger despite her psychic denial. By the time she became Medicare eligible at 65, the lump had progressed to a suppurating dinner-plate-sized, red crater where her breast had been before. Her raw and open cancerous wound looked like a shotgun had been fired point blank into her chest. The entire OR was shocked by the worst case of cancer we had ever seen.

There are many reasons Maria's story is tragic, but one point seems particularly unfair: For 40-plus years of work, she had paid into a private health insurance plan, paid Medicare taxes, and federal and state income taxes supporting Medicaid and the local county hospital. Maria had been paying for health care all her life - just not her own. But when push came to shove, Maria was pushed and shoved into her early grave, by not fitting into the coverage regulations during her time of need.

The cynical part of me (and some of you may be nodding your heads, I suspect), recalls the medical "free-riders" that Maria helped support: for example, the deliberately uninsured who chose not to have health coverage, potentially ineligible individuals who abused the MediCal system for care, and people who slipped through loopholes in the rules to get primary care treatment in emergency rooms. Those patients were subsidized by Maria, who somehow was a last priority for health care. The health care entitlement line was too long for Maria.

After her surgery, I had a chance to briefly meet with Maria's family in the waiting area with the surgeon—her large family included her husband, sons and daughters, and wide-eyed grandkids treating us deferentially as they absorbed the tragic news about their Maria, a beloved wife, mother, grandmother, U.S. citizen and hard-working, long-time employee.

Maria, and literally millions like her are in the sweet spot of health care reform. They work, pay taxes, raise families, have mortgages, credit scores and bank accounts. In short they have bought into the American socioeconomic model of life. They also have bought into the health care financing system, which at times seems almost “Bernie Madoff” in design.

We may not all agree on PPACA (aka Obamacare) but we must find a middle ground; a way to stop the sound bite arguments, and hit the sweet spot of health care reform. We must effectively cover the Marias, and the political economy of health care will hum. We didn’t hit the mark in time for Maria, but we can for millions of others. Anything else is just more hacking.

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