Observation of the Affordable Care Act in Rural Oregon

More than an opinion piece, this is an update of how the Affordable Care Act is affecting my practice in a rural Oregon community. With the ACA, many more people now qualify for Medicare. They have swamped our clinic and when I should normally have spare time on my hands as a new provider trying to build my patient-base, my schedule fills up almost daily with new patients trying to establish care.

Many of these new patients are ticking time bombs: they have not had health care in years but yet have serious chronic problems. They come to me with long laundry lists of concerns, many are in what I consider to be crisis mode with off-the-chart blood pressures and spilling sugar into their urine because of uncontrolled diabetes. They have moles, bumps, lumps, growths, pain, asthma, COPD, discharge, limited ability to move and so on. It is impossible to review everything that needs to be reviewed within the cushy 30 minutes allotted to each patient.

For these reasons, my schedule is further filling up with follow-up appointments. In an effort to keep these patients out of the hospital, I am seeing a few of them on a weekly basis trying to get them to an acceptable baseline. It is a lot of work. It is also very expensive as many of them need to be referred to specialists at this point. I can't help but to think if they had been treated sooner things would not have progressed to such a demanding state.

It does my heart good, however, that the majority of my patients are very cooperative. I prescribe the medications, make the referrals and provide lots of education and they are listening to me. Maybe I have been in healthcare long enough that I forgot that there are people who do not understand what exercise is, who don't understand the basic food groups, who can't understand the labels on the medication bottle. When I explain these little things to them, they have incorporated them into their daily routine. I love it when my patients beam because they dropped a couple pounds or their blood pressure is "within range"--they are proud that they are doing the right thing. And when they say they feel better--well, my day is made. It is my opinion that people as a whole want to take care of themselves but they do not know how.

That said, I think it is a shame that we have large parts of our population that have been in the dark for so long. It is a huge disparity that should never exist in a civilized, progressed society. Yet we keep insisting that healthcare should only belong to the people that can afford it. We insist that insurance companies with their medical directors making multi-million dollar bonuses for cutting costs and reporting profits to shareholders is the better option.

The people I treat work in jobs like construction, farming, milling and other very hard labor jobs. Very few of my patients are actually unemployed but they could not previously afford health insurance. And these jobs that I listed, these are jobs that the rest of us need to have filled so we can perform our jobs, too. I need someone to build the roads I commute on, to make the paper I put my signatures to, to harvest the vegetables I put on my table.

Such it is: we live in a world where things cycle around. We need a healthy working class and to have that, we all need access to healthcare. I don't think the ACA is a perfect solution as there is still a large sect of working class that is still caught in the middle--not able to afford private insurance but still too "rich" for Medicaid--but many people have benefited. I hope that watching this change will drive us closer to a single-payer system when we can all assume that basic healthcare is part of any decent society.