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My resident admitted a patient with abdominal pain last night. This morning the local paper carried an op-ed piece by George Will outlining the Republican vision for health care.  It is clear that there are many different ways that this debate could go. After reading George Will and reflecting on how things might change given what might happen in the next couple of years. The Republican vision (as articulated by George Will) is that my patient would be given a $5700 tax credit for a “family plan”. He would then be on their own to purchase insurance that presumably would cost that or more if he chooses  more coverage.

My patients don’t make very much money. I have to assume that this gentleman comes from a household that makes less than $31,000 per year (median household income in Mobile) and so will likely choose not to spend additional household income on health care coverage as I suspect Mr Will would choose to do. Since currently the average person in Alabama is spending $5000 per capita (or $15,000 per family), my patient’s family will probably need to select an “insurance plan” that will be 50% cheaper than what they are getting from their employer now. Ah, you say, my patient will become an informed consumer and will then drive down costs by purchasing quality health insurance.

My patient lives in Mobile. He got his abdominal pain in Mobile and came to a Mobile hospital. My patient has had previous abdominal surgery. If he purchased the wrong insurance from “Fly-by-night” Insurance company with headquarters in Delaware, will there be a clause that says “must be accepted by hospitals in Mobile Alabama?” One of the problems with the current system and with the “proposed” system is patients who think their insurance was “good” at their nearby hospital but when illness strikes  in the middle of the night they find themselves without coverage. Neither Mr Will nor Tom Price (author of HR34oo) offer a solution to this problem. The bill in conference would not allow this.

My patient had previous abdominal surgery. It is likely that due to this pre-existing condition, he would be unable to get inexpensive health coverage in an actuarial based system. He would be required to make the choice to carry more expensive health coverage, to lie (and risk getting caught and having all claims denied), or to go without coverage (a choice many make today). HR 3400 does not address this issue. The bill in conference does.

My patient is ill due to no fault of his own. His illness came over him suddenly. He works at a job which probably provides as much utility as the hedge fund managers who were rescued with our tax dollars. The security given by access to quality healthcare is important to keeping his (and people like him) life together. I don’t think a tax credit is going to do the job.