Skip to main content

Despite flaws, health care law is needed

By Kevin Pho, Special to CNN
updated 4:01 PM EDT, Mon March 26, 2012
A health clinic in New York City.
A health clinic in New York City.
STORY HIGHLIGHTS
  • Supreme Court will hear arguments about the constitutionality of the health care law
  • Kevin Pho: Despite flaws, we should go forward with the Affordable Care Act
  • He says current health care system does not adequately address needs of patients
  • Pho: health reform is necessary, but we also need a strong primary care foundation

Editor's note: Kevin Pho is an internal medicine physician based in Nashua, New Hampshire. He blogs at MedPage Today's KevinMD.com.

(CNN) -- With the Supreme Court set to hear oral arguments about the constitutionality of the President Obama's health care law, more patients than ever have been asking for my thoughts about health reform.

I practice primary care in southern New Hampshire near the Massachusetts border, which gives me a firsthand look at how health reform has impacted my neighboring state. Despite flaws with the Massachusetts approach, and the president's Affordable Care Act which is modeled after it, I believe that health care reform needs to move forward.

Read a transcript of Monday's court arguments

Over the years, I have encountered too many cases of patients who are inadequately served by our current health care model. Some of their stories are heartbreaking, others are deeply worrisome.

Kevin Pho
Kevin Pho

Some time ago, I had one middle-aged patient with diabetes, whom I'll call Mark, requiring high doses of insulin to control his blood sugar. He faithfully saw me every three months, where I made careful insulin adjustments so his sugars wouldn't go too high or low. But all of a sudden, he stopped coming. I didn't hear from him until a year later, when I received a call from the emergency department telling me Mark was found in a coma because of a critically high sugar level. Thankfully, he survived his hospital stay, and when he came for a visit afterward he explained how he had lost his job, and thus, his health insurance. He couldn't afford to see me or buy his medication.

According to the 2010 Commonwealth Fund survey, 72% of jobless Americans said they couldn't afford to fill a prescription or obtain needed medical tests. Worse, 40% said that medical bills forced them into difficult financial decisions, such as depleting their savings, or being unable to pay for necessities like food, heat or rent. These are choices patients should never be forced to make.

Health care reform's day in court
Health care law: A storybook explainer
GOP: Repeal and replace health care law

But it's not only patients without insurance who suffer. Others are in a situation like another patient of mine, whom I'll call Linda. She recently told me that her sister was diagnosed with colon cancer, a disease with a strong genetic component. I recommended that Linda have a colonoscopy. Unfortunately, her health insurance plan had a deductible in the thousands of dollars, making a colonoscopy prohibitively expensive.

Last year, a study from the RAND Corporation, a nonprofit, nonpartisan research organization, found that families enrolled in high-deductible plans like Linda's cut back on health care that was clearly beneficial, like cervical cancer, breast cancer and colon cancer screening. According to the study, "these cutbacks could cause a spike in health care costs down the road if people end up sicker and need more intensive treatment."

The Affordable Care Act would help patients like Mark, by providing him a way to obtain affordable health insurance regardless of his job status. Beginning in 2014, health reform would expand the eligibility of Medicaid and provide federal tax credits to help buy private insurance. On average, 17% of the nonelderly population nationwide would be helped, with numbers as high as 36 to 40% in parts of Florida, New Mexico, Texas, Louisiana and California. And for patients like Linda, health reform would prohibit cost sharing for many preventive screening tests, including colonoscopies.

My support of the Affordable Care Act is tempered, however, by a serious flaw: Its benefits cannot be fully realized without a strong primary care foundation. In the United States, the number of specialists to primary care doctors is about 70-30, a ratio that's reversed in the rest of the world. That primary care deficit is a far bigger threat to health reform than if the Supreme Court were to rule President Obama's law unconstitutional.

Having health insurance doesn't necessarily mean that you'll be able to see a doctor. In Massachusetts, more than 95% of residents have health insurance, the highest in the country. However, a 2011 Massachusetts Medical Society survey found that more than half of primary care doctors were not accepting new patients, while the average wait time for an appointment exceeded one month. When you consider that health coverage will expand to 32 million Americans in 2014, whether our strained primary care system can handle that burden is a serious question. An inability to see a primary care provider will force patients to already crowded emergency departments, where health care is often the most expensive.

The Affordable Care Act doesn't do nearly enough to make primary care enticing, despite the anticipated shortfall of primary care providers approaching 30,000 by 2015. Medical students, concerned by their average school debt approaching $160,000, often eschew primary care in favor higher paying specialties. And the bureaucratic burdens of primary care, including paperwork and spending time on the telephone refuting insurance company denials, are overwhelming. According to an Annals of Internal Medicine study, 30% of primary care doctors considered leaving the field entirely, citing burnout, time pressures and administrative hassles.

These concerns, however, shouldn't stall health reform. Instead, they need to be addressed as the Affordable Care Act is modified and improved on in the coming years. Far too many patients can no longer afford to obtain basic care. It's their stories that have made me realize we desperately need to fix our broken health care system, and accept health reform despite its shortcomings. We cannot let the pursuit of perfection become the enemy of doing the right thing.

Patients like Mark and Linda need help now.

Follow us on Twitter @CNNOpinion

Join us on Facebook/CNNOpinion

The opinions expressed in this commentary are solely those of Kevin Pho.

ADVERTISEMENT
Part of complete coverage on
updated 10:17 AM EDT, Tue July 29, 2014
LZ Granderson says the cyber-standing ovation given to Robyn Lawley, an Australian plus-size model who posted unretouched photos, shows how crazy Americans' notions of beauty have become
updated 7:56 AM EDT, Mon July 28, 2014
A crisis like the Gaza conflict or the surge of immigrants can be an opportunity for a lame duck president, writes Julian Zelizer
updated 2:22 PM EDT, Sat July 26, 2014
Carol Costello says the league's light punishment sent the message that it didn't consider domestic violence a serious offense
updated 8:51 AM EDT, Mon July 28, 2014
Danny Cevallos says saggy pants aren't the kind of fashion statement protected by the First Amendment.
updated 2:52 PM EDT, Mon July 28, 2014
Margaret Hoover says some GOP legislators support a state's right to allow same-sex marriage and the right of churches, synagogues and mosques not to perform the sacrament
updated 2:31 PM EDT, Mon July 28, 2014
Megan McCracken and Jennifer Moreno say it's unacceptable for states to experiment with new execution procedures without full disclosure
updated 2:50 PM EDT, Mon July 28, 2014
Priya Satia says today's drones for bombardment and surveillance have their roots in the deadly history of Western aerial control of the Middle East that began in World War One
updated 12:35 PM EDT, Mon July 28, 2014
Jeff Yang says it's great to see the comics make an effort at diversifying the halls of justice
updated 11:55 AM EDT, Sat July 26, 2014
Rick Francona says the reported artillery firing from Russian territory is a sign Vladimir Putin has escalated the Ukraine battle
updated 2:22 PM EDT, Sun July 27, 2014
Paul Callan says the fact that appeals delay the death penalty doesn't make it an unconstitutional punishment, as one judge ruled
updated 6:25 PM EDT, Thu July 24, 2014
Pilot Robert Mark says it's been tough for the airline industry after the plane crashes in Ukraine and Taiwan.
updated 11:10 AM EDT, Fri July 25, 2014
Jennifer DeVoe laments efforts to end subsidies that allow working Americans to finally afford health insurance.
updated 11:33 AM EDT, Sat July 26, 2014
Ruti Teitel says assigning a costly and humiliating "collective guilt" to Germany after WWI would end up teaching the global community hard lessons about who to blame for war crimes
updated 8:45 AM EDT, Fri July 25, 2014
John Sutter responds to criticism of his column on the ethics of eating dog.
updated 9:02 AM EDT, Fri July 25, 2014
Frida Ghitis says it's tempting to ignore North Korea's antics as bluster but the cruel regime is dangerous.
updated 2:50 PM EDT, Fri July 25, 2014
To the question "Is Putin evil?" Alexander Motyl says he is evil enough for condemnation by people of good will.
updated 2:03 PM EDT, Thu July 24, 2014
Laurie Garrett: Poor governance, ignorance, hysteria worsen the Ebola epidemic in Sierra Leone, Guinea, Liberia.
updated 9:49 AM EDT, Thu July 24, 2014
Patrick Cronin and Kelley Sayler say the world is seeing nonstate groups such as Ukraine's rebels wielding more power to do harm than ever before
updated 6:05 PM EDT, Wed July 23, 2014
Ukraine ambassador Olexander Motsyk places blame for the MH17 tragedy squarely at the door of Russia
updated 7:42 AM EDT, Thu July 24, 2014
Mark Kramer says Russia and its proxies have a history of shooting down civilian aircraft, often with few repercussions
updated 2:53 PM EDT, Thu July 24, 2014
Les Abend says, with rockets flying over Tel Aviv and missiles shooting down MH17 over Ukraine, a commercial pilot's pre-flight checklist just got much more complicated
updated 9:17 AM EDT, Thu July 24, 2014
Mark Kramer says Russia and its proxies have a history of shooting down civilian aircraft, often with few repercussions
updated 12:37 PM EDT, Thu July 24, 2014
Gerard Jacobs says grieving families and nations need the comfort of traditional rituals to honor the remains of loved ones, particularly in a mass disaster
updated 10:13 AM EDT, Thu July 24, 2014
The idea is difficult to stomach, but John Sutter writes that eating dog is morally equivalent to eating pig, another intelligent animal. If Americans oppose it, they should question their own eating habits as well.
updated 12:30 PM EDT, Wed July 23, 2014
Bill van Esveld says under the laws of war, civilians who do not join in the fight are always to be protected. An International Criminal Court could rule on whether Israeli airstrikes and Hamas rocketing are war crimes.
updated 10:08 AM EDT, Wed July 23, 2014
Gordon Brown says the kidnapped Nigerian girls have been in captivity for 100 days, but the world has not forgotten them.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT