Editor’s note: This commentary is by Walter Carpenter, of Montpelier, who works in Vermont’s tourist business and is a writer, health care activist, and a member of the Green Mountain Care Board’s Advisory Board.
This September my doctor called me with some disconcerting news. The symptoms of a hip going bad were all there. It was just a matter of time. I had been in for X-rays the previous day to see whether I needed to get a new or refurbished hip right now or if I could put it off.
Neither choice was good. I work in the tourist industry — which funded Vermont last year with $2.8 billion plus $391 million in taxes — but with no such thing as paid sick days or family leave, I would have to suffer weeks or months of lost income as I recovered from the surgery.
Then came worse news. The X-rays turned up something else that needed more attention. The problem showed up as a glossy white spot against the flatter color on the hip bone. That awful word of cancer materialized to suck the breath out of me. If so, it was most likely bone cancer and probably incurable. My mother’s father succumbed to bone cancer in the 1960s. My mother passed on from cancer in 2006. Could this be my turn now?
With fear shaking my insides like a volcano, I began preparing for battle against this deadly foe. I informed employers, family, friends, landlord what was up and took stock of my resources. I would need everything that I possessed from finances to internal strength.
I recalled those feelings of shock as I read Vicki Loner’s attempt to clear up the confusion about OneCare. She did a commendable job of making the basics of OneCare comprehensible. This is not easy and she admitted as much with how trying to understand OneCare is confusing “given how immensely complex health care is in general.”
This is true enough. Yet, this complexity is also the first problem with OneCare and our health care’s costly and deadly chaos. Our health care should not be more complex than the creation of the universe. My question here is how would OneCare would make it less complex. When I took stock of my options as I digested the grim possibilities discovered by that visit to the X-ray machine, I immediately faced this insane complexity.
The first complexity, of course, was insurance. It was not about the care to try to beat this scourge, but the logistics of insurance. Fortunately, I am on Medicaid. Medicaid is not complex.It is fantastically easy as a health system ought to be and is everywhere else in the democratic world. As a patient, a taxpayer, and a voter, I sincerely thank the state of Vermont for that. It is what unearthed the glossy spot in the first place. Without Medicaid, I would have deferred those X-rays until I hit Medicare age — barely a year away. By then, of course, it might have been much too late. If the X-rays’ surprise discovery was deadly, it would be the second time being in Vermont saved my life or gave me a fighting chance to do so — but that is another story.
Loner described how OneCare’s all-payer model “shifts our focus from treating illness and disease once they have occurred to preventing onset in the first place. We call this delivery system reform.” The real problem is not delivery, but access. We need access reform.
With the threat of cancer hanging over my head, I knew that my Medicaid had to be “re-upped” midway between now and Medicare eligibility. What if I lost it during treatments? Then what? America has the world record for bankruptcies caused by medical debt. I have had several friends who lost their insurance during their cancer treatments. It was their tough luck. One died from it. Oh, well. Would that be me?
To borrow a line from the British rock band, the Moody Blues, only the “Days of Future Passed” will tell us if OneCare is the reform that will “make a real difference for Vermonters.” Until then, relief from the sheer complexity and cost of access to health care is the reform needed most by Vermonters the soonest. So far, despite all the hard work and sweat on implementing the accountable care organization and its delivery reform, OneCare’s reforms do not solve our never-ending problems of access to health care.
My guillotine of immediate complexities got lifted from my neck when further tests reprieved me from the gallows: No cancer. The spot was a bone lesion that needs to come out at some point, but it is not fatal. Now all I have to do is find a new hip somewhere.
