Bloomberg Government Insider

Care Providers on the Affordable Care Act


The nurse practitioner-in-training
Gerald Whitney Santangelo, 47, of Arlington Heights, Ill., quit his job at Hewlett-Packard (HPQ) this year. He’s studying to become a nurse practitioner.
 
For the last 16 years I’ve worked at Hewlett-Packard in several senior sales positions. I’ve recently made a decision to go back to school. It was an absolutely gut-wrenching decision. I’m giving up a salary of more than $150,000 a year. I’ll be lucky to make 50 percent of that. At the same time, I believe in universal health care. I wanted to find where I could serve the individual, not an organization.

We’re going to need nurse practitioners. It’s going to be a very long process, and it’s actually very daunting. I’ll be 54 or 55 at the end of my studies.

So now I find myself at the local community college taking prerequisites because you really have to take a lot of science just to apply to nursing programs. Certainly it is a little strange with looks I’m getting from kids—’Who’s this old dude? Why is he here; what’s wrong with him?’ Overall, I’m having the time of my life.

I’m not Don Quixote. I’m a practical person that wants to provide a solution. We used to say in business: ‘You can’t boil the ocean.’ You look at what you can impact and put a plan in place. What I can impact is helping a small community have basic health-care services.

I don’t expect everybody to quit and become a nurse. Everybody could participate in their own way—whether it’s supporting reform or putting out ideas of what positive change could be. But sitting back and just saying ‘no’ is not a solution.
 
The primary-care doctor
Dr. Kohar Jones, 34, is a family physician who works part-time at the Chicago Family Health Center, a community clinic on the South Side of the city.
 
I’m a National Health Service Corps scholar, which means the government paid for me to go to medical school, and in return I pay the American people back by serving an underserved community.

The ACA has been really positive so far. There’s been $11 billion allocated for community health centers and $6 million of those came to Chicago Family Health Center, enabling us to revamp a clinic in the Pullman neighborhood.

In many ways ACA is health insurance reform rather than health-care reform. There have been some important changes to protect patients from lack of coverage.

I see the need all the time. I see it with diabetics—they stop buying the medicines they need. One patient lost his job, lost his insurance, then lost sensation in his hands and feet because his sugar was so out of control. He stepped on a nail and didn’t notice it until he smelled it, and then he had to lose his foot. Insulin, when it’s not subsidized, costs $100 to $200 a month, but that costs so much less than disability and sickness, losing a limb.

We need a health-care system, and the ACA doesn’t give us a system. It gives us shifts and incentives within a health-care hodgepodge that has too many people falling through the cracks. The point of a system is to promote health and ultimately find a way to do that efficiently, effectively, and encompassing as much of the population as possible.
 
The business advocate
A former Republican governor of Michigan, John Engler, 63, is president of the Washington-based lobby group the Business Roundtable.
 
Businesses would like to have a significant say because the Roundtable companies are the health-care innovators. As the people who write the checks, our concern has been the rising cost.

The law is complex, it’s expensive, and I think increasingly difficult to implement.

There is a very strong belief among business health-care providers that the private marketplace is still very important and that transparency and accountability are two components that have been missing in some ways.

The taxes that are levied are of great concern. This is driving the cost up now. At this point, the benefits are de minimis compared to some of the costs.

To me, a much more consumer-directed, market-driven health system is highly desirable. Just because someone’s poor doesn’t mean they’re not fully capable and desirous of playing a bigger role in making health-care choices and decisions. We have to keep in mind that we spend dramatically more than anybody in the world on health insurance, and we do that despite not getting health care that’s dramatically better than everybody else.

The debate is not over. The obligation on the part of business and other groups is to actually bring forward ideas and alternatives that would deal with the fundamental problem, that we want people in the 21st century to be having access to health care when they need it.
 
— As told to Leslie Patton and Christopher Flavelle


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