By Wil Dubois
Ladies and gentlemen, please take your seats. I need your undivided attention. We're going to talk about this whole healthcare reform thing. Whoa, whoa. Sit back down! Please. Hey! Sit down and shut up!! Now is not the time for debate, picket signs, or rabid sound bites.
The Patient Protection and Affordable Care Act is now the law of the land. It doesn't matter how you feel about it — that fact isn't going to change any time soon. Even if there's a tectonic shift in political power this fall, an appeal of the Act is a statistical impossibility.
Look, I don't want to talk about your politics, and I'm not going to talk about mine. But there are big changes afoot in the land, and you should understand what they mean for your diabetes, for you, your children, your parents, your doctor, and for our country.
What's in a name?
First, names have power. And Obamacare is a lie. Oh, don't get me wrong. I'm quite sure that Mr. Obama cares. But this law wasn't written by the President. It was written by Congress. Well, by a hair over half of it, anyway. So it should be called Congresscare.
The full name of "Obamacare" is The Patient Protection and Affordable Care Act, sometimes just called the Affordable Care Act, or ACA. That's its name, and that's what I'm going to call it: the ACA. I think that the name "Obamacare" sets people off, in one direction or the other, and I want to de-politicize the law for today's discussion. I just want to talk about the nuts and bolts of the law. What it will do, what it will not do, and how it will affect all of us. Because, frankly, most people, no matter how they feel about the ACA, don't really know what's in the law.
And why is that? Well, I suspect the problem is that a 974-page law that rolls out over a decade is pretty much sound bite-proof. It's not something the evening news can summarize easily. Given the time constraints of modern life, and the uncertainty — until recently — about the law's continued existence, most people just haven't had the time and energy to look into it. It's big. It's complicated. And there's a lot of nonsense about it in the media and on the web.
Now, I work in healthcare. I write about healthcare. I have diabetes and a host of other medical problems. You'd think I'd be pretty well informed about the ACA. To be honest, until I was given the assignment of "simplifying" the ACA, I only knew the broad outlines of the Act. It's been a fascinating journey for me, learning more, getting under the covers of the debate and getting intimate with the law itself, and then figuring out how to distill the information down for you.
And, healthcare reform isn't healthcare reform at all
Wikipedia's voluminous entry on the ACA calls it the "most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965." I respectfully disagree. There's a lot of stuff in the ACA, but it's largely health insurance reform, not healthcare reform. The vast bulk of the ACA leaves the American Healthcare "system" intact. What it does do is add a new layer of consumer protection while, in essence, requiring most people to buy into the market.
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Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...