HEALTH -- May 2, 2012 at 2:49 PM EDT
Health Reform on the Brink: Mixed Feelings in Maine
Editor's Note: This story is part of a series profiling the views of ordinary Americans and their experiences -- good, bad or indifferent -- with the health care reform law. To capture the essence of the opinions expressed, the stories are told from the perspectives of the interviewees. They do not reflect the views of the PBS NewsHour.
As Jeff Aronson sees it, few things encapsulate the American health care dilemma as well as a car crash on the island of Vinalhaven, Maine.
Not the shattering glass and twisting metal of impact, but the aftermath -- the ambulance ride, the hospital stay, and, eventually, the stacks of bills from both. Emergency medical technicians like Jeff hear the same worries too often when they arrive at a scene of distress: "I can't afford the bill for an ambulance ride."
Vinalhaven's emergencies -- not just its auto accidents but its heart attacks, accidental burns, and broken limbs -- may take a little longer to treat than elsewhere in the nation. It is, after all, an island community an hour-and-a-half ferry ride from the mainland. But for the most part, the lobster fishermen and small business owners who fill this town struggle with the same rising costs and public health woes as the rest of the nation.
Jeff has seen his friends and neighbors forgo needed procedures because they simply couldn't afford them. He's experienced the strain when the island's volunteer ambulance service is "strapped by inadequate reimbursements." And he's grown close with both the low-income workers of the state and the high-end vacationers who travel there during the summer -- and both groups worry about the future of their health care.
It's fairly clear to Jeff that some type of health care reform is necessary. But, he said, "the Affordable Care law doesn't do anything for these issues." It may expand access to 32 million more Americans, but the law itself is a far cry from "real health care reform," largely because it's a law built on the idea that three concepts -- personal responsibility for health, the health care system, and the health insurance industry -- are virtually interchangeable, he said.
But they're not the same -- at least not the way Jeff sees it. He would like to see a much larger cultural debate, in which some pretty basic questions are raised and answered collectively: What's the role of health insurance at all? Is it to protect us in the case of catastrophes, so you don't have to declare bankruptcy to get your appendix out? Is it there so that you don't avoid potentially useful check-ups because you can't afford them or don't want to spend the money? Or is it to provide us with a way of funding a relatively healthier nation?
But that's getting ahead of the story. To understand Jeff Aronson's ideas about health care reform, it's helpful to know a bit more about Jeff Aronson.
The hospital was "fairly barren by American-hospital standards," Jeff said. No big gift shop, no fancy lobby, "but everything was very clean."
Jeff had traveled to this hospital in Frejus, France, immediately after he heard the news -- his girlfriend had been in a serious auto accident. At the time, Jeff was working in Nice, helping to run an exchange program for the University of Vermont. And after several visits to the country, he had grown quite close with a French woman and her four-year-old child.
And now here she was, lying in a hospital bed. "And the one thing I remember asking her was, 'What will your employer do if you can't get back to work? Surely as a single mother, this concerns you.'"
She looked confused by his concern. Under French laws, she said, her employer couldn't dock her pay because of a medical situation. All of her costs from the accident were covered, "to the point where she had no stress about what was going to happen. She didn't face financial ruin over it."
It raised "a different kind of idea about where health care factored in your life," Jeff said. He began thinking more about his own generous benefits package through the University of Vermont, and wondered what would happen if he were in a crash back home.
Jeff's own accidents were a little less dramatic. He broke a leg sliding into second base during an intramural softball game (but "the run scored," he said). And he was in so many skiing crashes that he began dislocating his shoulder. "I was falling because I was trying to do more than I should have," he said.
It eventually got to the point where his shoulder would fall out when he was simply trying to put on a seat belt.
With his university sponsored health insurance plan, Jeff could afford physical therapy to improve range of motion on his shoulder. But it may have come a little too easily.
When his physical therapist discovered that he had been lax on his home exercises, she told him a story. It involved a much older patient who was going through the same thing around the same time -- a Vermont farmer who "significantly dislocated his shoulder" when he fell from a hayloft. The difference was that this older gentleman was working hard at his exercises, and he would be back to normal in no time.
"Now as someone who ran every day, that got my competitive juices up, and I got pretty mad at myself," he said. "But I also got pretty puzzled at the whole situation -- why I was getting employer health care as a worker at the state-supported University of Vermont, while this farmer was probably doing it off his own dime to get back to work."
It not only made Jeff question the fairness of the employer-based insurance model, it made him re-examine his own views on the very concepts of health, health care, and health insurance. The farmer took full responsibility for his personal "health" -- a virtue strengthened by the fact that he needed it to remain a productive member of society. He most likely relied on the diagnosis and treatment of the medical establishment (i.e., the health care system) only when he absolutely needed it. And -- as Jeff imagined this man -- his "health insurance," if he had any at all, was simply a means of paying the unexpected medical bills. It wasn't a blank check to be lazy or reckless about personal health, and it certainly wasn't an excuse to rely on the "health care system" to do the heavy lifting of treatment and recovery.
Jeff admits his physical therapist could have been making the whole thing up to motivate him to try harder. She probably didn't intend for the story to be an epiphany about the American health care system. But it worked on both counts.
A New Course
In the early 1990s, Jeff left the shelter of traditional employment in search of a more "public setting." He found it the right mix in a set of freelance jobs in Vinalhaven, Maine -- employment that collectively brings in "far less income than I once earned" and no health insurance.
He now edits a national magazine for Land Rover enthusiasts and leads library reading discussion programs. He's also an EMS volunteer, a caretaker, carpenter and landscape worker for summer home owners. In recent years he's been a sea urchin tender and dock worker. Collectively, they keep him happy and fit.
"When I went out on my own, I realized that I needed to make sure I stayed healthy because I couldn't afford not to be," he said.
If the Supreme Court leaves the health care reform law intact, Jeff would be "forced" to either purchase health insurance or pay a fine starting in 2014, he said. And for someone who "earns below average wages, it's unlikely that any health care plan contemplated by this law will be truly affordable," he said.
So does Jeff think that's wrong, or somehow illegal? "No. It's not a violation of a constitutional right," he said. "There are plenty of things that governments -- at all levels -- tell us we have to do. And we accept them or repeal those laws."
But the law also doesn't do much to reward people like Jeff for their efforts to remain in good health, he said. It doesn't provide parents with the peace of mind he saw from the universal coverage in France. It doesn't encourage the responsible living that comes naturally to a self-employed farmer in Vermont. It doesn't even provide much relief to a fisherman off the coast of Maine when he's worried about an ambulance ride.
"And it's all because this law tiptoes around that central issue of what we mean by 'health' and 'health care' -- and what we would like to do, as a society, to provide and maintain both," he said. "Since we haven't done that -- since much of this debate avoids the point entirely -- I don't think it's going to work as well as its proponents hope. But I also don't think this is the constitutional catastrophe that its wildest opponents say it is, either."
Do you agree with Jeff Aronson? Or are your views of the health care reform law closer to supporter Lisa Hill or opponent Ron Castle? In the weeks ahead on the PBS NewsHour's Health Page, we will continue sharing the stories of ordinary Americans who love, hate, and feel indifferent about the Affordable Care Act. As the Supreme Court decides the fate of the law, we want to hear your verdict. Share your opinions here.
Photos, as shown from top: Lobster boats surround the island of Vinalhaven, Maine; photo by Melanie Stetson Freeman/The Christian Science Monitor via Getty Images. Jeff Aronson talks with a friend; photo courtesy of Jeff Aronson. Stock skiing photo by Alain Grosclaude/Agence Zoom/Getty Images. Lobster fisherman Brennan Dyer unloads traps in Vinalhaven; photo by Melanie Stetson Freeman/The Christian Science Monitor via Getty Images.