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Journal of the American Academy of Physician Assistants:
doi: 10.1097/01.JAA.0000433835.19512.8c
Editorial

Health insurance and chocolate

Section Editor(s): Bushardt, Reamer L. PharmD, PA-C

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Reamer Bushardt is professor and chair of the department of physician assistant studies at Wake Forest School of Medicine in Winston-Salem, North Carolina, and editor-in-chief of JAAPA.

The keynote speaker at a recent meeting I attended remarked, “The way we deliver healthcare needs to be tied to good business practices, but healthcare is a human right.” Although his words resonated with me, his perspective is clearly not universally shared.

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Earlier this year, I participated in a neurosciences conference in Pennsylvania. This year, the conference emphasized innovations in healthcare delivery, including new models of care that are lowering costs while increasing quality and safety. The innovators at this conference clearly understand we are all in this together to make quality healthcare more affordable and sustainable. They are not engaged in watchful waiting for health reform to take hold. Their shift to value-based care through demonstration projects, such as one consultative service improving post-stroke outcomes, is more about doing the right thing for patients—and about hoping that payment systems will evolve to provide the incentive for doing the right thing.

I returned to my hotel exhilarated and more hopeful about the future. Which of these innovations could my own institution duplicate? I could not wait to get home and discuss several of the most successful projects with leaders from our clinical enterprise. I quickly packed and hopped aboard a hotel shuttle to the airport.

Three other people were also on the shuttle. They were obviously colleagues, positioning themselves one in front of the other for a three-way chat. They were very engaged in their own conversation, so I figured they didn't notice my arrival and that's why they didn't greet me as I climbed on board. Being genetically predisposed to Southern graces, I said “good morning” and received three pleasant nods in return. They quickly reverted to their passionate conversation.

I couldn't ignore them owing to the confined space of the shuttle. I learned they all sell health insurance and had just attended a workshop on how health reform will affect their business. Clearly this workshop was a hit, based on their invigorated commentary during the 18 minutes and 45 seconds I was trapped on that bus. The woman in the front seat turned completely around and perched on her knees to face her colleagues. The man seated in the middle radiated nervous energy and constantly twisted his head to and fro to engage his peers. I thought to warn him about torticollis but decided against it. The woman seated in the rear routinely produced a guttural sound intermittently disrupted by a hybrid laugh-snort. The fast pace of their conversation was impressive—all three were at imminent risk for respiratory alkalosis.

The tragic dénouement occurred about 5 miles from the airport. How was health reform going to hurt their bottom lines? The workshop had offered predictions and financial forecasts and, fortunately for them, several well-crafted contingency plans. They were concerned about what the insurance exchanges would do to their profits. They were livid over the provision of the Affordable Care Act that lets parents add or keep a child on a health insurance policy until the child turns 26 years old. My fellow travelers agreed that “without these 'older kids' paying premiums or facing deductibles, they are going to use more acute and preventive care, and that just cannot be good for business.”

I started to sweat. I was already pressed against the window trying to distance myself from their conversation. I had run out of room and was not yet prepared to jump from a moving vehicle. I reached for a piece of chocolate from my bag. I had purchased this treat before leaving the hotel, which, upon reflection, appeared to be the result of divine intervention. It was dark chocolate flavored with hickory smoke, almonds, and a hint of sea salt. I let it melt in my mouth, trying to deconstruct the flavors one by one. I drifted away from their conversation.

I learned three lessons and forged one new goal from this trip. Lesson one: Innovations in the way we deliver care are happening every day. I see the shift from disease-centered care to patient-centered care. Lesson two: The reality that my fellow travelers have likely been awarded bonuses afforded through the denial of care to people they have never met and the underuse of preventive health services by children is definitely food for thought. I recognize our current healthcare market needs better business practices. I hope public good will be served with increased competition through the exchanges. It is also clear to me now that health insurance companies make decisions every day that carry profound moral significance. Lesson three: Never underestimate the power of a delicious piece of chocolate.

In honor of my three friends from the shuttle bus, my new goal is to invigorate my efforts to promote preventive health services among those 26 years and younger. Improving their health and reducing profits for my fellow shuttlegoers might even taste better than that chocolate.

© 2013 American Academy of Physician Assistants.

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