Health Care: ‘Access’ vs ‘Coverage’ All in the Metrics

ALPERN AT LARGE--A judge ... a California judge ... a California AND an Obama-appointed judge ... just rejected a bid by 18 of our United States to revive subsidies to health plan for covering patients as part of the Affordable Care Act, or ACA.  Should we call that a defeat for health care?  Shall we call it a victory over federal government over reach?  Or both? 

Maybe both.  States rightfully and ultimately have the responsibility to take care of the health, welfare, education and other needs of their citizens, and the role of the federal government has been debated since the founding of our Republic.  But life is hell without health care coverage and access. 

It's that whole Constitution thing. 

And it's that whole "right" vs. "responsibility" thing.  Giving people something might offer them relief, but allowing them the opportunity to pursue and earn that same thing is both empowering and fulfilling in ways that the mere giving will not allow for. 

(A big exception:  true illness and disability.  Someone with leukemia or sarcoma or Alzheimer's is a victim, and must be offered help, be it from the private or public sectors.  Someone with backaches in their 50's is not a victim, and is almost always blessed with the ability to fight on and work any way they can to maintain their blessed independence and dignity.) 

That aforementioned judge was someone who made it clear that he liked the idea of the ACA but recognized that President Trump was within his legal rights to stop federal governmental payments to health plans. 

Just as President Obama was within his legal rights to maintain federal governmental payments to health plans. 

Just as Congress needs to get off its duff and make the rough, tough, but necessary decision as to repeal/replace Obamacare, repeal it altogether, or just to provide block grants to the states.  Ultimately, it's the role of Congress to make this decision, not a presidential fiat that can change after each new resident enters the White House. 

But it's still all in the METRICS. 

Access to health care ... good.  Canadians and Europeans often flee to the United States because they're "covered" but have no timely access to scans or procedures or treatments, or even flee to the U.S. because they have no allowed access due to their age or other parameters. 

The METRICS of access are as important as coverage. 

But what type of coverage?  High-deductible, high-premium costs that make one person a slave to another person's medical needs and costs?  That may seem darned fair to the person getting cheaper and affordable health care, but pretty darned horrible to the person paying infinitely more but getting infinitely less in return. 

Furthermore, there has to be a "bridge" between the past and the present and the future.  The Bipartisan Health Care Stabilization Act of 2017 is both pragmatic and cruel for those respectively benefiting from and suffering from the ACA.  But whether it's kicking the can down the road or being smart during the years 2017-2019, it’s worth paying attention to. 

And one can despise President Trump all one wishes, but he's hardly the first person to raise the concept of offering competition between state plans to reduce costs, or to allow large groups of small businesses and independent contractors the ability to band together to allow cheaper bids and more affordable health plans. 

In fact, many who favor the ACA and prefer to fix, rather than repeal/replace, even agree with President Trump (although they might still despise the President) on those issues. 

Hate him or love him, President Trump is revealing just how fragile the ACA really is, and what form of downward spiral it really, truly is. 

Many who are suffering under ACA premiums are just saving up and paying cash for their health care needs. 

Many who are benefiting under the ACA with affordable health care are fearful for the future. 

And they're both right. 

Health care access?  Health care coverage? 

Both critical--and both definitely achievable in this greatest nation on Earth.

(Kenneth S. Alpern, M.D. is a dermatologist who has served in clinics in Los Angeles, Orange, and Riverside Counties, and is a proud father and husband to two cherished children and a wonderful wife. He is also a Westside Village Zone Director and Board member of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Co-Chair of its MVCC Transportation/Infrastructure Committee. He was co-chair of the CD11 Transportation Advisory Committee and chaired the nonprofit Transit Coalition, and can be reached at He also co-chairs the grassroots Friends of the Green Line at The views expressed in this article are solely those of Dr. Alpern.)