Paulmeno: GOP Health Care Bill is Cruel, Abhorrent and Destructive

Letter to the editor submitted by Stephanie Paulmeno, MS, RN, NHA, CPH, CCM, CDPJune 26, 2017

Lives…actual lives… as well as the quality of health for millions of people are at stake if the GOP passes this latest rendition of their so called health care bill.  Virtually every organized health professional organization as well as the organizations representing health facilities and health organizations, disease entities, and health systems at every level have come out in opposition to this cruel, abhorrent and destructive bill. The AARP representing our nation’s seniors is actively opposed.

I am a health care professional, a Registered Nurse and Master’s prepared Gerontologist; for nearly a decade I was Director of Community Health Planning at a department of health. I’m a Board Certified Case Manager and Board Certified in Public Health as well as a licensed health facility administrator for decades. I spent 13 years as a Director of Nursing. I’ve watched people die in many settings and from many things including neglect… and this bill is a national policy of intentional neglect. I never thought that in America we would ever be considering, let alone approaching possibly passing a mass genocide bill, and make no mistake about it, that is what this is. Gassing people with poison gases is not really different from holding potential care and life-saving treatments in front of people and telling them that they cannot have that care…they are too poor, or too old or disabled, and therefore not deserving of adequate and effective health care; care they could often get at no cost in many 3rd world countries but not here in America, the former seat of the leader of the free world. So sad!  If this bill passes, I fear Putin will have won the skirmish, the battle and the war, all handed to him in a basket by Trump and his wealthy cronies and those legislators who are placing their political ambitions above the needs of the people whom they swore to serve.

I have been in health care practice for 48 years as a clinician, a researcher, a teacher and an administrator across the spectrum of health care. I’m still going strong with my own public health consulting firm where I conduct public health systems assessments and strategic planning and implementation for health programs, health systems organizations and groups. I am also President-elect of the Connecticut Nurses’ Association.

I can assure you that there is NO HEALTH CARE in either the House or Senate version of the GOP “health care bill”. They offer no health care whatsoever. They do offer people the opportunity to purchase sub-standard insurance policies that WILL NOT translate into essential prevention activities, actual health care or access to health care. This is going backwards to what we had in place before the Affordable Care Act required that all APPROVED plans include 10 essential services. In other words you will now be able, once again, to continue to fill the pockets of the wealthy insurance perveyors with your limited health insurance premium dollars, but you will NOT get health care for any significant health issue for your money. The costs of uncompensated care on hospitals will wreak havoc on their budgets and their abilities to provide care across the spectrum of people, populations, and health conditions; programs will be cut, jobs will be lost, hospitals,  especially in more rural locations, are likely to be forced to the point of closure. We give lip service to wanting to eliminate health disparities, but this bill rebukes these empty words for any Legislator who votes for it.

I served as an appointed Commissioner on the Connecticut Commission on Health Equity for its entire duration (2008-2016) and I can tell you we already have significant disparities in health care outcomes between people of means and those without as well as people of color, women, non-English-speaking folks, etc. This will increase them, and with our GOP government’s blessing. If it passes will we have another White House garden party to celebrate this GOP achievement?

The elderly and infirm and those with pre-existing conditions will experience significant rises in their premium costs and tens of millions of additional people will become uninsured. Data shows that the cost of insurance for these low income people and families will rise to a totally unaffordable annual rate; in many cases 5 times the rate of healthier people or tens of thousands of dollars PER YEAR for their annual insurance costs while they struggle to feed, house and clothe their families. The proposed “credits” for them are so appallingly low that they will not even cover many a singular medical procedure, diagnostic test, or medications. Is it the GOP plan to merely have these babies, children, adults, and seniors simply die off so the super-wealthy and the insurance companies can enrich themselves further? Talk about “death panels.”

As a nation we are in the midst of the largest and most disastrous substance abuse crisis we have ever known with related deaths doubling in some states just over this last year;  substance abuse and mental health issues are largely co-occurring disorders. its infinite wisdom, this bill intentionally cuts both mental health and substance abuse services making this an optional coverage point for states to include at their discretion through block grants. If they cover this, something else has to be cut. They will have to make the calls on which essential to your health. They will allow insurance companies to strip away such things as maternity care, ambulance services, ambulatory care services, emergency room care, substance abuse and mental health care, free preventive check-ups, screening exams and so much more. Remember that we are talking about services that are “essential.”

What is the outcome of this? A continued rise in drug abuse and exponentially increasing deaths with all the social woes that accompanies that! This is surely one way to reduce health care costs; Don’t offer prevention services, don’t provide health treatment or needed social supports, and just let them die off! That will surely cut health care costs! America is also grossly out of line in the amount of our monies that go to support social services in proportion to the costs allocated to health care services. The World Health Organization defines health as “the state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.”

They understand the principles behind the many social determinants of health that seem lost on the vast majority of our GOP legislators.

And what about the huge numbers of people in nursing homes, around 65% of whom are covered under Medicaid. When they are turned out for inability to pay, who will be caring for them? Will this be a repeat of the massive emptying out of our nation’s mental health institutions decades ago. Will demented and infirm seniors without family members be relegated to street corners and shelters? In many cases, where one exists, a family member will need to stop working to provide care in their own homes. Many of these long term nursing home residents suffer with dementia and need round-the-clock care and monitoring. As our population ages, the numbers of people with dementia is also rising. Is this GOP bill intended to be the proverbial iceberg float for millions of seniors.

This is not my America!

In fact this Senate bill removes virtually all the protections that were added through the ACA’s inclusion of essential services. It is a con job being foisted upon the American people, the vast majority of whom do not understand either the complex critical difference between access to insurance and access to actual essential care services that can and do sustain life. Nor do the vast majority of Americans understand the enormous complexities of the American health care system and the difference between individual health components, different health systems and population health, all of which are entwined but are separate and distinct entities in their own right. Yes, Mr. Trump, health care is very complicated and all its pieces are intertwined, interconnected and interdependent. The fallout of this orchestrated slow genocide will be felt across our population, in all sectors, for generations to come. If we let this pass we will have disgraced ourselves as a nation and as a people.

This bill is simply a not-so-well disguised mechanism to transfer an obscene amount of wealth from the poorest and most compromised in our society to the most wealthy 1% of our most privileged people. Any physician-legislator or health care provider-legislator who votes for this bill should lose their license as well as the privilege and honor of being called a doctor or health care provider. For shame!

What happened to the Hippocratic Oath commitment to “first do no harm.”

Each health profession has some equivalent of this oath and we all have ethics codes to which we must adhere. Apparently Congress does not.

This bill must be denied and those who vote for it should feel the wrath of the people at the voting polls in 2018 and 2020 even though Mitch McConnell craftily placed some of the devastating impact of this to play out after 2018 and 2020 elections.

America has the most costly health system of all other industrialized nations with some of the poorest health care outcomes in that same grouping of nations. We are the only Global North (industrialized) nation that does not offer a Universal Health Care System to its people. Shame on us!

Democrats and health care and public health professionals from all disciplines. We must get our public health message clearly crafted and out to the people.

Now is not the time for diplomatic word crafting. This bill will kill people and the public needs to understand that, understand how it will do that and why it is being done…to make a massive transfer of wealth in the form of tax credits from our poorest and most compromised people to the wealthiest and most privileged 1% of our population.