Starting with a CLEAN SLATE

Updated on August 28, 2023

Nick JacobsBy Nick Jacobs

In the book “Change or DIE” there is a reference to the fact that, when confronted with life altering decisions, about 90% of us make the choice not to change, not because we are suicidal or obtuse, but because resisting change seems to be built into our DNA.

Immediately before my son went to college, he appeared in the kitchen and asked us if he could “get some things off his chest.”   He wanted to start this next part of his life with a clean slate.   The first thing that came out of his mouth was, “Dad, your car does go 140mph,” and that was the beginning of about thirty very uncomfortable minutes of reconciliation.

As we enter the New Year, there is at least one thing that I’d like to “get off my chest,” because it has become increasingly apparent to me that I’m conflicted.  I’ve always embraced the underdog in both my life and my career.  As a teacher, my personal mission was usually wrapped around helping some kid who could have easily gone to the dark side.  This typically was accomplished by motivating him or her into attaining a goal that was perceived to be unattainable.  It was a “Climb every mountain“ scenario where their own self-worth became evident to them, and they realized that all of life does not have to be bad.   Many of those students are still my friends decades later.

My reconciliation to you today is that I was a rabid believer in finding a way to provide healthcare to all of the citizens of the United States.  Like millions of others in this country, my own job experiences sometimes took me to the brink of being uninsured and there was no family trust for us to dig into to cover our health insurance costs.

As a hospital CEO, I had also seen those very tragic cases where the young mom had underestimated the speed with which infant illness can progress, and due to her lack of understanding of the healthcare system, waited a day too long to bring her baby to the Emergency Room where it died in her arms.

My position also allowed me to understand the Charge Master and cost shifting so that the poor could be taken care of regardless of their ability to pay.  It was the uninsured or underinsured, working poor who typically were hurt the most by this system because they not only were billed full charges (which never happened to those of us who had insurance), but they were also turned over to bill-collectors.  These under-insured could literally have their homes taken from them for the unpaid balance of some catastrophic event and the resulting charges.

Consequently, when the Affordable Care Act looked as if it was going to pass, my defending the poor mentality kicked into high gear; that was until I realized that the first such healthcare bill to pass since 1948 was the definitive reconciliation package.  It looked like a duck but smelled like fertilizer.  Hospitals lost $500B in Medicare fees while pharmaceutical and insurance companies maintained all but a small percentage of their previous profits.  (They are huge employers in our country.)

Fee for service was still the primary driver while wellness and prevention took a typical back seat in the program and family practice and internal medicine physicians were still financially undervalued.   Worst of all, the government clearly displayed its inconceivable ineptness by creating a catastrophic misfire during the computerized enrollment roll-out.

I’m sure that my desire to support the underdog will never fully vanish, but the fight to support this camel shaped bill has created quite a quandary for me.  Yes, I’d still rather spend a trillion dollars on healthcare than on war, but people are getting hurt in both scenarios, and it appears to be, like so many other government decisions, all about the lobbyists.

Nick Jacobs, FACHE, International Director of SunStone Management Resources and an officer on the American Board of Integrative Holistic Physicians, is currently consulting in Integrative Medicine and Pharmacogenomics and writes the blog,  

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