Learning about Obamacare from a car accident

Just a little over a week into 2014, my new year started off with a bang — literally — as I got into an automobile accident that involved my car sideswiping another vehicle and then crashing my car into a tree at 30 MPH. The car was totaled, but fortunately, I (mostly) walked away from the accident with only a fractured sternum and bruising.

Just a little over a week from the accident, I’m doing fine — back at work, only modest discomfort.

I bring up my accident because it taught me some valuable lessons, which I think are applicable to the ongoing debate over the Affordable Care Act. As I blogged in the Philadelphia Inquirer recently, government regulation probably protected me from sustaining a much greater injury from my accident. I encourage you to read the entire post, but let me summarize the salient points:

1. We all are invincible, until we aren’t. Accidents and illnesses can happen at a moment’s notice, whether you are a 57-year-old like me, who always assumed serious auto accidents are something that happens to someone else because of my heretofore spotless driving record, or whether you are a 27-year-old “young invincible.” When you get sick and hurt, you will need good health insurance, which I was fortunate to have through my employer, the American College of Physicians, but millions do not. Opting out of insurance coverage, at any age, is just plain dumb.

2. We may not like it when the government infringes on our personal liberties by requiring us to buy products we think we don’t need, sets consumer safety standards for the products we buy that add to their cost, or requires or forbids us from doing certain things that can endanger us — but such mandates sometimes are necessary to protect us from greater harm. In my case, federal requirements that cars have seat belts, airbags, and front end collision protection likely protected me from far more serious injury, even death. Such mandates added hundreds, maybe thousands of dollars, to the purchase price of my car, but they were worth every penny when my health and safety depended on them. (If I had driven a “grandfathered,” older car that lacked air bags and other federally-mandated crash protections, I may not be here writing this blog today). My local government required that I buy auto insurance, another unfunded mandate on me. It required me to wear a seat belt and shoulder restraint system, another mandate to prevent me from doing something really stupid, driving without a seat belt. Sure, even without such mandates, I would have worn a seat belt and bought auto coverage on my own, but this unfortunately is not true of everyone on the road.

3. So it is with Obamacare: the government requires us to buy health insurance, because having good health insurance is essential when you get sick or hurt. The government mandates that the health insurance that is sold to us meets consumer protection and benefit standards, like no pre-existing condition exclusions and coverage of essential benefits, so that the coverage actually helps us when we really need it — even if it means we have to pay more for it. Just like the government requires that the new cars we buy have safety features we may think we will never need or use, like airbags, until we do and are glad we have them.

4. I am fortunate that I already had good health insurance coverage through my employer, but there are millions of uninsured persons that have had no access to health insurance, or only had access to inadequate plans sold on the individual insurance market — until Obamacare came along to set standards for the insurance industry and provide financial help so people could afford it. Contrast my experience last week with those who do not have good health insurance. Here is how I put it in the Philadelphia Inquirer blog:

Now, let’s think about what might have been the outcome for someone in the same circumstances as me, but without health insurance and with a much more modest income. Because this person didn’t have health insurance, he might have decided not to go to the ER, he might not have gotten the prescriptions filled because of the cost, making his recovery much more painful (believe me!).

The hospital ER might have written off some of his costs by cost-shifting to people with insurance, but he still might have left with a huge bill. He might have missed more days of work without pay. And if his car didn’t have airbags and he wasn’t wearing a seatbelt, he could have suffered a catastrophic life-threatening injury.

Now, consider the tens of millions of people who find themselves in the same circumstances but who lacked good coverage before Obamacare. They will now be required to buy and will get government help in purchasing health insurance that by law must include essential benefits. Their new coverage will also meet various consumer protection standards, like a ban on discriminating against people with pre-existing conditions and on lifetime and annual limits on coverage. The consumer protections in their new coverage will protect them from going bankrupt if they need healthcare. These safeguards may even be what keeps them alive. Many of them may not think they need this protection — until they do.

Now, I know that some readers of this blog will argue that it is “paternalistic” for the government to require that we buy health insurance that has benefits that we think we don’t need or want. I have argued that setting standards for health insurance companies isn’t really paternalistic, while my friend Dr. Bob Centor argues in his DB’s Medical Rants blog that it is. I will concede his point — government mandates that limit our personal choices or regulate the products we buy are paternalistic, to a point.

But when I drove my car into a tree, it was government paternalism that likely protected me from greater harm, just like Obamacare’s paternalism protects us by requiring that everyone have health insurance that meets federal consumer protection standards, so that when we get sick or hurt (as we all will at some point), we have health insurance that helps keep us medically and financially sound.

Bob Doherty is senior vice-president, governmental affairs and public policy, American College of Physicians and blogs at The ACP Advocate Blog.

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  • Ron Smith

    Hi, Bob.

    Pretty soon the government will create a regulation to prevent you running into trees like that. That will be great won’t it!

    Will life be nothing if not sterile or even worth living?

    Nothing but shill again, Bob. The more you say it doesn’t eventually make it true.

    Respectfully,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • SarahJ89

      Don’t you think we should also make it against the law for trees to text whilst standing? Much safer.

  • Martha55

    EMTALA should be repealed and people who do not have the means to pay should not rely on the rest of us to foot the bill.

    • Lisa

      In otherwords, die quickly if you are poor.

      • Martha55

        If you are poor, you can sign up for Medicaid.

        • SarahJ89

          Ya think? Think again. For most of my life my state refused to allow intact families to receive Medicaid. This meant a husband and wife with limited or no insurance or high deductibles/co-pays had to SEPARATE in order to get treatment for their child. Did you hear that? Would you seriously wish that on anyone facing a life-threatening cancer diagnosis in their child? Do you really think its in society’s best interests for them to separate?

          What people did instead was seek treatment at a major medical center in the next state. They were not refused, thank goodness. They were refused in our own state, however.

          That neighouring state spent multi-millions per year treating children from my state. The taxpayers and patients with insurance picked up the tab as our state boasted of its low taxes.

          The reality is, we could turn that clock back anytime. My state has been targeted by a very conservative group who dismantled a lot of laws a few years back. It will take decades to repair the torn social fabric.

          So no, Medicaid is by now means a shoo in. And you do know the income limits, right? You do realize that in my state you cannot own a car worth more than $5,000. You have to sell it and buy a junker. Which makes it so easy to keep those medical appointments. Not.

      • fatherhash

        According to that logic, why not have an EMTALA type law for restaurants?….. Should the poor not be fed?

        If someome argued against it, would you say they want them to “starve quickly if they are poor.”

  • John C. Key MD

    You are wrong again Bob. I would like to think that it was good personal decisions on your part, rather than government planning and regulation, that caused you to obtain both health and automobile insurance. If others in the accident did not, you probably had “uninsured motorist” coverage as well.

    When did personal responsibility and individual initiative get to be such a bad thing? After all, it is what made the country great, but now our leadership is trying to destroy both, and whatever government offers as a substitute will be a very poor approximation of the real thing.

  • NewMexicoRam

    So, that’s the government’s role–to make sure people are “protected” against all harm in life.
    That’s an entirely different perspective than I have.
    Government is not the protector of life. That’s God’s role.
    I’m not all anti-government. But when the government says people here have to pay more to ensure people there have everything covered, then that’s enough.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Well, the government is certainly empowered to make sure that the cars we buy are “safe” cars, but the government is not (yet) empowered to make us buy a car in the first place, and nobody is asking taxpayers to fund an automobile for every worker.
    On the other hand, government is expected to ensure the provision of decent public transportation and roads, bridges, sidewalks and rails (e.g. infrastructure), and taxpayers are expected to pay for all those public things.
    The health of the nation, as opposed to individual health insurance (whatever that means), is public infrastructure.

    • Lisa

      I think that a single payer health system should be part of this country’s public infrastructure.

      • PoliticallyIncorrectMD

        I am not sure a monopoly, especially government ran, is a great solution.

        • SarahJ89

          I’m really not so sure we don’t have a monopoly already. The medical system is essentially run by corporations nowadays. The fact they each have different names doesn’t seem to matter much in the end.

          • PoliticallyIncorrectMD

            Very much true… Therefore monopolizing it further is not going to make things better. Allowing market mechanisms to work, eliminating gigantic beurocratic and regulatory machine and assuring price transperency would be much better option.

      • Thomas D Guastavino

        I would be more then happy to support single payer the moment we as physicians can collectively bargain.

  • Michael Rack

    regarding government regulation: you are lucky the accident didn’t happen 10 years from now. Gov fuel economy standards would result in you driving an aluminum piece of junk that would be less safe in the case of an accident.
    Regarding your cost-shifting comment: It still exists, but now instead of the cost shifting being towards the privately insured, it is towards taxpayers (primarily in the form of paying for the Medicaid expansion)

  • Bill Viner

    “Health insurance that keeps us medically and financially sound”? I think it’s premature to make that statement. Our government has taken an overly complicated system and made it even more complicated. I seriously doubt that better health and increased savings will occur. The problem with big government is that the people making the rulebook are so far removed from the actual players, that they have no idea of what the actual outcome will be. This is a perfect storm if you asked me (which I know you didn’t). We have a new government monstrosity and ICD10 meeting together later this year. I’m going to sit back and watch how this unfolds from a distance. I moved to NZ 3 years ago because; #1 NZ is awesome, and #2 I began to hate being a doctor after 12 years in private practice. I would be interested to know how much it cost to insure each new addition after the money we’ve spent just on the website alone. We should have had a single payer system with option to purchase additional private coverage, such as NZ has. It works well, and I would wager that my hourly pay here is better than what I made there. Good luck and God bless!

    • Dr. Drake Ramoray

      Not much market for Endocrinology in NZ or Australia, I looked a few years back. Had I been in primary care I may very well been there with you.

      • Bill Viner

        A colleague at our hospital is an Endocrinologist from Chicago, but he is probably employed as an IM doc. I do O&G, so the job market is pretty good, but what I really love are the clinic hours, the ACC (no fault injury system), the doctor’s union, and the ability to do private work as well. People do have to wait for elective surgeries in the public system, but they don’t seem to mind, and they’re actually very appreciative. Australia is a little different, but the money is better from what I’m told. It’s more difficult and expensive to get started there.

        • Dr. Drake Ramoray

          Family now, and local ties so not much of a go. Yeah I was told I could probably make it work but would be lots of IM. Life has worked out very well for me, but I did take a look at NZ and Australia at one time, so I know where you are coming from.

          • Bill Viner

            Completely understand. I brought my wife and six children over. Took the 2 eldest a while to adjust and took me a few months as well. Glad it has worked out for you. I was generally seeing things progressively getting worse with no signs of improvement. I wish I could’ve made the move sooner, but I had my student loans to pay back first. Hope things go well with the ACA, but I am far from being convinced.

  • Dr. Drake Ramoray

    I think we are headed towards single payer (or at least a two tiered system) within the next ten years. And for statistics like life expectancy the US doesn’t fair very well. Of course, that is mostly due to the fact that we have more cars, more guns, the most sedentary, and the most overweight population on earth.

    When you look at actual individual metrics of healthcare delivery like cancer survival the US beats almost every other nation on almost every kind of cancer. Table 5

    http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-027766.pdf

  • Dr. Drake Ramoray

    As a measure of GDP the difference in output from small vs large business has not changed very much in the United States after the industrial wind down with the end of World War 2 and the shift to nuclear deterrence. See link at the end.

    In addition your selected time frame also includes a period of time where the US had the only functioning industrial capacity following WWII. Germany and France didn’t recover to 1940′s industrial output until the mid 1960′s

    http://history.stackexchange.com/questions/10984/what-did-germany-do-after-world-war-ii-to-recover-so-successfully-that-it-became

  • Dr. Drake Ramoray

    You will get no disagreement from me that healthcare in the US is too expensive. I will say with further consolidation and the charging of hospital facility fees, healthcare in the US is only going to get more expensive in the short term.

    http://www.publicintegrity.org/2012/12/20/11978/hospital-facility-fees-boosting-medical-bills-and-not-just-hospital-care

  • SarahJ89

    Oh my. I’ve lived in countries with successful “socialized medicine” that I loved and wish we had here. But I nearly lost my cookies with the rah-rah tone of this article.

  • SarahJ89

    Um, “if they can’t pay” is the very essence of poverty.

  • SarahJ89

    I agree. My dear friend in Ireland received state-of-the-art treatment for his mesothilioma (which I’ve misspelled). Except his widow wasn’t left destitute. And his doctor made home visits at the end.

  • SarahJ89

    ” If people want to live in a country with a political/economic model that resembles a European country, why not move to Europe?” That is precisely what my husband and I are doing. I lived in Europe, can’t wait to go back to live.

    People don’t move to Europe because they have family and economic ties. Not everyone is up for a major cultural adjustment. And it’s expensive, trust me. Making a long distance move is a luxury for which we have been saving for years. We have about one more year to go.

    There’s nothing wrong with not moving. There’s everything wrong with being wiling to accept garbage because it’s what you were raised in. You should be striving to improve things, not keep them the same all the time, especially when the statistics and ethical issues are so stacked against you.

  • SarahJ89

    I presume you’re talking about current US medical systems, right? My experience has been exactly as you describe for about ten years now.

  • Sara Stein MD

    Simply put and well said. Hope you feel better soon! Whether it’s a life-threatening injury or illness, or a short term misery that needs sutures or antibiotics or a cast, health insurance is a life and home saver. Even the most invincible can see the possibility of a fracture from skateboarding, or a teeth rattling bronchitis, or a gash from a slipped tool. Interestingly the excuse I hear most often is “I’m hoping I’ll get a job soon so I won’t need it”. To which I say, “you can quit Obamacare if you get a job with insurance. but until then…don’t leave the house, certainly don’t drive or walk outside, don’t drink alcohol or do drugs, don’t eat any food that upsets your stomach, don’t take any medication, get 8 hours of sleep and try not to trip on your treadmill.”

  • SarahJ89

    Unfortunately the ACA (and thank you for not calling it Obamacare) is a political train wreck. I have never been in favour of it so we can agree on that. I never thought “people need health insurance” because I see health insurers as leeches upon the body politic. They take our health care dollars, invest them, make money on them and then process the bills. They have a vested interest in not allowing medical care. Coupled with the US’s odd obsession with looking only at short term performance… No, people need health care, not health insurance.

    Frankly, given the many special interests, level of corruption and the fact we actually live in a corporate-run society I’m not optimistic about any proposed solution being successful here.

  • SarahJ89

    No filo, one person or one administration does not a train wreck make. That takes two parties. One administration would come up with something you might hate, but it would be consistent and have its own internal logic. The ACA has neither because it is the bastard child of political compromise.

  • Sara Stein MD

    Because you are already paying for medical care for the uninsured through your tax dollars given as tax breaks for charity care to hospitals, tax levies, subsidies. That $500,000 multiple fracture motorcycle accident in the 30 yr old uninsured guy? You and I paid for it. Not sure why anyone thinks keeping people uninsured saves us money. Btw, the issue is not driving a car into a tree. The issue is being sideswiped on the highway in a rainstorm and rolling your car and getting out alive because of your seatbelt and airbags.

  • Sara Stein MD

    I have no interest in convincing you of anything. You’re in the bleachers calling a game, unless you want to unmask yourself as a health care provider. Re trauma “The effect of trauma on productive life years lost exceeds that of any
    other disease. The economic cost of 50 million injuries in the year
    2000, alone, was $406 billion.1 This includes estimates of $80 billion in medical care costs, and $326 billion in productivity losses.” http://www.nationaltraumainstitute.org/the_case_for_trauma_funding.html

    • Filo

      I’m not sure you are interested in a meaningful dialogue Sara. I asked you several questions which I was hoping and genuinely interested in getting answers to. Instead I get a “no interest in convincing you” from a person who has had enough interest to address me not once, but two times; along with a, “You’re in the bleachers…” deflection. A monologue with no argument supporting the ACA.

      My opinion may very well may be wrong regarding insurance and the ACA, but you only validate the argument I have raised in this thread.

      For the record, I returned to school at the age of 30 to pursue a career in medicine and I’m currently in med school now. But that really has nothing to do with this particular discussion.

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