We’re taking a chance today because if we don’t, and we’re right, we will regret not speaking up.

After a recent hospital stay, we received an email inviting us to join the hospital’s “Portal.”   From doctors’ offices earlier, we had received the same sort of communication.  Sign up and all your medical records will be kept in one place so that, in future, if you need care, other (new) doctors can see and understand what and why by simply going online and reading.

Our initial reaction was that we didn’t want “other” doctors to read all about us.  We didn’t imagine that bogus MDs would be interested and could figure out some way to profit from this information – apart from doing what was promised.   We just thought that enough was enough, the Internet was all well and good but it needed limits and standards of which there was not much evidence.

Reflecting, we realized we weren’t getting younger, and perhaps it would be wise to enroll in this program, for future problems.  So, reluctantly, we said,  “Yes, sign us up.”

To make this story proverbially shorter, after we conferred with the hospital staff who were running the Portal, we learned something key.

The hospital would have its portal.  So would my other doctors – have their own special portal – which would NOT be included in the hospital’s information.  Which is to say, each incorporated medical practice would have a medical portal separate from all others.  In an emergency, if someone actually needed to see the information within, they would have only a portion of it.   To get a compete medical portrait of our status, doctors’ staffs and doctors themselves would have to track down every portal in which we were enrolled, which would be impossible (unless they knew every doctor and/or procedure accomplished and visited in earlier years.)  When we asked why this was so complicated and incomplete, we were told it was because “Obamacare” set up the system.   This was part of Obamacare.

It was further explained to us how Obamacare worked and why it was not working, why it had become the political football it has.

This was the best, easiest to understand, and simplest explanation of Obamacare and its flaws we had ever heard.

What it boils down to is that there are 51 Affordable Care plans in these United States, one for every state and one for the District of Columbia.

Each plan MAY be different from all the others, and NO plan is identical to any other.   Expanding, in each state insurance companies can be as different as each state offers or requires.

In an effort to walk slowly towards universal healthcare, the medical architects of the Affordable Care Act (doctors? legislators?) decided that the power of the profession should go to the states rather than involve an umbrella called the federal government.  States’ Rights had a chance to pass and become law, whereas another Big Government Program was sure to be defeated in Congress.

Suddenly we understood what Donald Trump was shouting about, wanting “the lines” that separate states removed.   If the Affordable Care Act was to have any chance of actually working, Mr. Trump wanted uniformity –not of premiums but of consistent levels of care and the reasons behind it.

Mr. Trump would, we think, have favored portals to be sure, but not four thousand of them.

We considered all this for a few days and then decided that perhaps if we were right, we should let others know.

It wasn’t just the “roll-out” that was defective and not ready for prime time.  Regardless of the successful components of the plan, its very construction – and its agonizingly careful unveiling – seemed to us to guarantee confusion and ultimate collapse.

Most clearly, if what is good in the plan were buttressed, and what is bad about the plan (c.f., “portals”) deleted or rewritten, then the oft-mentioned 11 million newly insured Americans should help their congressional representatives “replace” (not repeal), refine, re-imagine a healthcare system that can be made to work as well as Medicare does.

It’s certainly possible that Mr. Trump’s inability to communicate clearly what he envisioned confused the issue by stepping on its common sense and possibility.

We apologize to him.


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