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Letter: One Last Health Care Volley

First let me thank Congressman Ackerman and his staff for responding (“Exploring Health Care Legislation,” The Roslyn News, April 15, 2010) to my letter to the editor that was published in The Roslyn News on April 8. I’m glad I stimulated Congressman Ackerman to talk to us about this legislation.

Before addressing the issues that I raised in my letter, Rep. Ackerman uses several hundreds of words to provide ad hominems and personal attacks consistent with Saul Olinsky’s Rule for Radicals, specifically Rule No. 5, which is to obfuscate the issues raised by an individual by employing personal attacks on that individual. I will defer comments on this until after I address Rep. Ackerman’s comments on the issues that I raised.

Ackerman’s ad said, “Starting this year; your children’s coverage can’t be denied because of pre-existing conditions.” On March 29, 2010, days after Ackerman’s ad appeared, Health and Human Services Secretary Kathleen Sebelius acknowledged that the law as written prevents health plans from dropping a child’s coverage due to an illness in a plan already covering the child, but, it did not prevent health plans from denying coverage due to pre-existing conditions to a child who was not already covered by a plan. Secretary Sebelius continued and said, “I am preparing to issue regulations in the weeks ahead ensuring that the term ‘pre-existing conditions exclusion’ applies to both a child’s access to a plan and to his or her benefits once he or she is in the plan.” Good for Secretary Sebelius! Deep into Rep. Ackerman’s reply to my letter, he admits that he was in error by stating, consistent with Secretary Sebelius’ statement, that regulations will be issued to correct this flaw.

Deep into Rep. Ackerman’s letter he makes a statement that should be divided into two parts. The first part states, “…even under New York law, insurance companies could deny payment for claims related to a specific pre-existing condition for up to one year.” The part of the statement concerns payment for services, i.e., coverage. Rep. Ackerman continues, “For one year, in New York State, your child could have been denied treatment for something like a birth defect, asthma, juvenile diabetes, cancer, leukemia, or sickle cell anemia…” This part of the statement concerns treatment, that is, patient care. Insurance coverage and patient care are different. This is the reason that I addressed patient care as well as insurance coverage of children in my letter.

First the issue of coverage. As I understand it, an employer may not be required to cover you from day one of your employment. If you change jobs the new employer may not cover you for a period equal to the number of months that you were unemployed between jobs, but not greater than one year. If this closed window is a major problem it should be addressed specifically.

The second part of Rep. Ackerman’s statement above relates to treatment, i.e., patient care. In my letter of April 8, I referred to New York State Physically Handicapped Programs as a source of care for children up to the age of 21 years. Some examples of the conditions covered by these programs are: cerebral palsy, muscular dystrophy, asthma, sickle cell anemia, diabetes, heart conditions, depression, mental retardation or developmental disability, conduct disorder, autism, and attention deficit hyperactivity disorder (ADHD), precisely the conditions mentioned in Rep. Ackerman’s statement.

Then there is something else; and this I say based upon my professional history. I have held the following positions: director of pediatrics, Fordham Hospital; chairman of pediatrics, Misericordia Hospital; the first chairman of pediatrics of the “new” Lincoln Hospital Medical Center. At that time, these institutions were all part of one medical organization in The Bronx. Subsequently, I was chairman of pediatrics at Brooklyn Hospital Medical Center and then chairman of pediatrics at Booth Memorial Hospital Medical Center, now New York Hospital-Queens. I then became the first medical director of Developmental Disabilities Institute and helped develop and open a network of Article 25 facilities that provided health care, from podiatry to dentistry, primarily to developmentally disabled children and adults. At no time was any child denied care because of the status of his or her insurance in any of these institutions. I’m sure that this is the policy of the leaders of these institutions today.

With regard to my discussing New York’s “Young Adult Option” Rep. Ackerman affirms that what I wrote was correct. He adds that New York also has a “Make Available Option.” That someone has to pay for this additional coverage is obvious. Depending on which plan it is, the someone may be an employer or the person being covered. The coverage in the Healthcare Act that Rep. Ackerman cites will also require that someone pay for it.

And now let me address Rep. Ackerman’s innuendos and aspersions concerning me in the first part of his letter. Because I use the word Obamacare twice in the next to last paragraph in my letter, according to Ackerman, I am a “conservative ideologue who never wanted health insurance reform in the first place.” Is Rep. Ackerman engaging in guilt by verbal association? He continues, “These people use ‘Obamacare’ as a derisive and derogatory slogan to demonize – as they do the president – this serious attempt to deal with one of our nation’s most serious problems.” When did the linkage of our president’s name with what the president believes is a great achievement become a pejorative? If Ackerman has a better short term for the Patient Protection and Affordability Act let him propose it. Furthermore, Paul Krugman’s blog, “The Conscience of a Liberal” topic for February 22 was … Obamacare. Now what does Ackerman think of him.

In his last paragraph, Rep. Ackerman implies that I am an opponent of health insurance reform because I cited my views on the coverage and care of children and young adults in New York State. What I do object to is the statement often made that our health care system is broken. Are improvements needed? Yes. They always are. Should health care be more affordable? Yes. Should we always attempt to improve the quality of care? Yes. What we don’t need is a system that has brought new and worse problems in other parts of the world as well as in Massachusetts.

There is much more that can be said about Rep. Ackerman’s letter. Who are the 42 million uninsured? President Obama referred to 30 million in his speech to congress. The president subtracted the 12 million who are illegal aliens. At least a significant majority of the uninsured children included would qualify for one of the currently existing programs, Medicaid or Child Health Plus, if someone would apply for them.

I urge our Congressman to hold an open Town Hall Meeting, so that our congressman can interact with his constituents.

Melvin Hollander, MD