John Geyman: 'The Human Face of ObamaCare' and what comes next

The Human Face of ObamaCare: Promises vs. Reality and What Comes Next

By John Geyman, M.D.
Copernicus Healthcare, January 1, 2016


Now that the Affordable Care Act (ACA) has been upheld by the U.S. Supreme Court as the law of the land, it is the target of an intense partisan debate during this 2016 election cycle. Confusion, disinformation, and misleading rhetoric dominate the airwaves as politicians and their corporate backers offer up wildly different approaches to our health care problems and solutions.

After six years with the ACA, there is a large base of experience to draw upon to assess, on the basis of evidence, what has worked and not worked. So it is time to reassess its impacts on the problems it was intended to address--reduced access to health care, uncontrolled costs, increasing unaffordability, and unacceptable quality of care for our population.

Despite promises of the Obama administration before the law was passed that we can keep our insurance if we like it, stay with our same doctors, and save money at the same time, many millions of Americans have too often found these assurances to be empty. Having insurance "coverage" for many does not translate into having access to affordable necessary care. Instead, the largely for-profit "system" continues on, profiting and sometimes profiteering from expanded markets subsidized by us, the taxpayers. The original title of the ACA as the Patient Protection and Affordable Care Act (PPACA) has become a misnomer, not surprisingly little used today.

Too we are often bombarded by abstract numbers and statistics that neglect what they mean to ordinary Americans. This book takes a different approach, starting with stories of patients and their families, thereby putting a human face on the large body of experience and evidence about the effects of the ACA since its passage in 2010.  Far from isolated anecdotes, these are common stories that best illustrate national trends and problems in our increasingly dysfunctional market-based system.

The book is organized in three parts: Part One presents some 50 patient and family stories that represent problems confronted by implementation of the ACA since 2010. These are real people and their families drawn from press reports. Part Two looks at five major problems of the entire system, as we consider to what extent the ACA has addressed them, and find that we are far from the health care reform that we need. Part Three deals with where we are now, in the middle of an election year, faced with three main alternatives about where to go next: (1) stick with the ACA or try to improve it; (2) repeal and replace it with a Republican "plan"; or (3) move to single-payer system of national health insurance. You will notice that many of the chapters start with a heading, "The Promise", "The Premise," or "The Myth." These denote either the promises made by the Obama administration about the ACA or the premises underlying it, which typically and ironically are based on earlier conservative ideas put forward by conservative organizations, such as the Heritage Foundation.

The stakes are too high to get health care wrong in this country. Our incremental reform attempts over many years have been compromised by the money and political power of corporate stakeholders that perpetuate many of our problems. We need objective evidence to combat the rhetoric and claims of the medical-industrial complex and direct our attention to the  real needs of patients and their families. It is my hope that this book will help in this process.

--John Geyman, M.D. 
Friday Harbor, WA
January 2016




By Don McCanne, M.D.

Although many had high hopes for ObamaCare, as John Geyman shows us the human faces, we realize that reform fell too short for too many. He shows us not only those human faces but also the pained face of health care justice. He provides us with an understanding of what is wrong with our system, and then describes options for the future. He encourages us all to participate in the reform dialogue so that we can finally get this right. "The Human Face of ObamaCare" is a great place to start.