Late last week, Sen. Jeff Sessions (R-Ala.) argued that before the Affordable Care Act came along three years ago, the United States had the "greatest health care system the world has ever known." He added that the pre-reform system was "marvelous."
By most measures, that's insane. It's true that the United States has some of the best medical professionals, health care facilities, and medical technology, but the health care system itself was a dangerous fiasco -- which is precisely why so many Americans have demanded changes for so long. The system itself cost too much, covered too few, and was the only system in the industrialized world that allowed families to go broke when a loved one got sick.
Consider this health care "lottery" in Nashville, and tell me (a) how the most prosperous nation on the planet tolerates such conditions; and (b) how this in any way resembles the "greatest health care system the world has ever known."
Two nights a year, Tennessee holds a health care lottery of sorts, giving the medically desperate a chance to get help.State residents who have high medical bills but would not normally qualify for Medicaid, the government health care program for the poor, can call a state phone line and request an application. But the window is tight -- the line shuts down after 2,500 calls, typically within an hour -- and the demand is so high that it is difficult to get through.There are other hurdles, too. Applicants have to be elderly, blind, disabled or the "caretaker relative" of a child who qualifies for Medicaid, known here as TennCare. Their medical debt has to be high enough that if they paid it, their income would fall below a certain threshold. Not many people end up qualifying, but that does not stop thousands from trying.
The article is heartbreaking, but I hope folks will take a minute to read it anyway. Note the lawyer with the Tennessee Justice Center who receives calls from panicked Americans who can't get through to TennCare. Note the uninsured Nashville woman with crippling arthritis who said, "I don't ask for that much. I just want some insurance."
It reminds me of the free clinics that are sometimes held in struggling areas, where thousands arrive before dawn, with many sleeping in their cars, hoping to see a physician. Indeed, let's not forget Wendell Potter, who left his job at a major health insurance company to tell the public the ways in which the industry "put profits before patients."
When Bill Moyers asked what prompted his change of heart, Potter said he visited a health care expedition in Wise, Virginia, in July 2007. "I just assumed that it would be, you know, like booths set up and people just getting their blood pressure checked and things like that," he said. "But what I saw were doctors who were set up to provide care in animal stalls. Or they'd erected tents, to care for people.... I've got some pictures of people being treated on gurneys, on rain-soaked pavement. And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care."
Potter added that families were there from "all over the region" because people had heard, "from word of mouth," about the possibility of being able to see a doctor without insurance. He asked himself, "What country am I in?"
Reading about struggling people in Tennessee hoping to win a Medicaid "lottery" leads me to ask the same question.
It's worth emphasizing that the Affordable Care Act will make a world of difference for millions of struggling Americans, providing them access to insurance that they currently lack. But implementation of "Obamacare" is staggered, and many of the coverage benefits don't kick in until 2014 -- and even then, many will have to know they're entitled to care and hope they're not in one of the Republican-led states trying to prevent Medicaid expansion.
As for Sessions, if he looks at this system as the "greatest health care system the world has ever known," I'm inclined to believe he's in the wrong line of work.