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Disruption

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With no Republican Platform and four more years of “the Disrupter in Chief” looking likely, we better start embracing disruption.

I have argued the health care industry in this country could use it. We have a huge, wasteful medical industrial complex that isn’t serving our “health”. It serves our 401k’s maybe, but we are not getting the health care we pay for.

But we keep buying it.

The Affordable Care Act was not an attempt at disruption, despite what the Freedom Foundation claims. It tightened some insurance industry regulations, it mandated universal coverage through a tax penalty and it tried to make individual coverage affordable. But it was essentially based on the current health insurance system. Democrats howled that the “government option” wasn’t included. Obama tried to buy Republican votes. He didn’t want too much disruption. Maybe that’s really what the Republicans want, major disruption.

Maybe when our President is reelected and his Supreme Court nominees get to hear the Republican lawsuit to overturn the law, they will find it “unconstitutional”. Then we can go back to the good old days when 40 million were uninsured. No doubt it will be many more now, with the higher costs and higher unemployment. Losing health insurance coverage, through loss of a job or unaffordability, or through SCOTUS decision in the middle of a pandemic will be a disrupter. Maybe that’s what America wants, disruption.

This wave of Covid-caused unemployment has given us a few months to see what disruption feels like. A survey back in June when unemployment was at 13% found about a fifth of the people who had lost their jobs were now without health insurance coverage. Even more telling, the majority who had lost their jobs did not have health insurance coverage through that now-gone employment. Like always, disruption hits the poor hardest.

It was amazing that the vast majority (74%), Republicans (65%) and Democrats (80%) thought the government should make health coverage available and affordable for them if they lost employment-based coverage.

You get disruption when you tear down a system. Heck, even minor tweaks can get peoples shorts twisted. Remember the outrage, the Tea Party fervor, the Fox News tirades about the Affordable Care Act? They made it sound like this middle of the road proposal was as threatening to our freedom as fascism. Where was Antifa then?

Even if you have a plan to replace what you tear down, the change can be painful. But the “repeal and replace” bumper sticker is fading on the Trumpwagen; no replacement in the Republican Platform. Actually, there was nothing in the Republican Platform at this year’s crowning, ahem, convention except “we want whatever He wants”.

So, we are experiencing pandemic disruption and it’s affecting people’s attitudes toward healthcare. If Trump and Republicans get what they say they really want, that is the repeal of the Band Aid Affordable Care Act, we might find ourselves in just the state of chaos we need.

Then, since Congress can’t act, can’t govern, can’t deliberate, we might get the miracle “Executive Order”. Halleluiah.

And that will mean the end of our representative democracy. We might just be proving we are incapable of governing ourselves. I hope not. I fear so.

Many times, when talking with patients about their healthcare decisions, I sensed their confusion, their frustration with the uncertainty of a choice their health was placing before them. Often, they would ask me to decide for them. “What should I do, doc?” It’s very tempting. Indeed, I have seen many doctors decide for patients what they thought “was best”.

But experience has taught me, people always do better when they have ownership of the decisions they have to live with. And that’s what our representative government system is supposed to promote, shared ownership of decisions for the common good. Let’s not give up on it.
 

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