By TAYLOR J. CHRISTENSEN

Without the full support of congress behind him, President-Elect Joe Biden will probably not have an opportunity to sign any major system-altering healthcare legislation. But, if Democrats can gain a majority in the senate–either this election cycle or next—healthcare reform will be high on the agenda. Let’s take a critical look at what Joe Biden would push to accomplish.

For this evaluation, I am relying solely on information that Joe Biden has committed to on his official campaign website. He has many pages talking about a variety healthcare issues, such as the pandemic, gun violence, and the opioid epidemic. But the main page that reviews his plans for the healthcare system as a whole is here. Consider giving it a read through first, because what follows will only be summarizing and evaluating the key big-picture components of his plan.

Joe Biden is not pushing for Medicare for All. He instead wants to keep the Affordable Care Act (i.e., the ACA, or “Obamacare”) and fix the parts of it that are not working so well. To understand the rationale of his proposed changes, we first need to review where we are at now with the ACA.

There are many parts to the ACA, but its main thrust was to increase insurance coverage. What kind of numbers are we working with? Below are some 2019 data, rounded for simplicity. And note that I am excluding the 60,000,000 people who are over age 65 and therefore on Medicare.

The under-age-65 people fall into one of four insurance groups . . .

Employer-sponsored insurance (160,000,000 people) if they are lucky enough to work for an employer that provides benefits.

Medicaid (70,000,000 people) if their income is low enough to qualify.

Private insurance from the “private market” (10,000,000 people) if they make too much money to qualify for Medicaid and do not have an employer that provides benefits.

Uninsured (30,000,000 people) if they do not get insurance from their employer, their income is too high to qualify for Medicaid, and they do not want to pay for insurance from the private market.

Remember, those are from 2019, so they are post-ACA numbers. Prior to the implementation of the ACA, the uninsured number hovered around 45,000,000 people. What did it do to reduce the number of uninsured people? There were many ways, but here are the two biggest ways:

By YASMIN ASVAT

An estimated 1.8 million people in this country may face a cancer diagnosis this year, in what has already been a bleak year of isolation and loss.  

While news of the COVID-19 vaccine rolling out across the U.S. offers hope in a year of 311,000 deaths,  11 million  people face the financial pressure of unemployment, and, approximately 43 percent of the nation reports some symptoms of anxiety or depression.  

It is understandable that a cancer diagnosis now may be too much to bear. And yet, somehow, many patients cope with the diagnosis and the associated uncertainty, fragility, and the threat of mortality with remarkable resilience.  

As a clinical psychologist in the Supportive Oncology program at a major Midwestern cancer center, I witness these quiet heroics every day. 

Since the beginning of the pandemic earlier this year, I have been striving to listen, empathize, support, and help cancer patients cope as their lives have been disrupted by both a cancer diagnosis and COVID-19. These are lessons these patients have taught me. 

Courage is being faced with doing something that utterly terrifies you, and you do it anyway. One of my patients described that leading up to the day of chemotherapy treatment, she is highly anxious, has racing thoughts and worries, and has trouble concentrating and sleeping. The morning of treatment, she vents to her partner about how she doesn’t want to go to the clinic. During the drive, she braces herself repeating, “I don’t want to do this” over and over again. 

Once in the clinic, she tells some of her nurses that she doesn’t want to be there because she worries about COVID-19 exposure, despite all the precautions the clinics have in place. She tells another set of nurses that she is scared of the side-effects of treatment – the disabling fatigue, the nausea, the suppressed immune system. 

By HANS DUVEFELT, MD

Growing up in Sweden without a Thanksgiving holiday, Christmas has been a time for me to reflect on where I am and where I have been and New Year’s is when I look forward.

I have written different kinds of Christmas reflections before: sometimes in jest, asking Santa for a better EMR; sometimes filled with compassion for physicians or patients who struggle during the holidays. I have also borrowed original sentences from Osler’s writings to imagine how he would address physicians in the present time.

This year, with the pandemic changing both medicine and so many aspects of life in general, and with a gut wrenching political battle that threatens to erupt in anarchy or civil war within the next few weeks or months, my thoughts run deep toward the soul of medicine, the purpose of being a good doctor, even being a good human being.

We live in ideological silos, protected from dissenting opinions. News is not news if it is unpopular. Fake news and fake science are concepts that seemed marginal before but have now entered the mainstream.

As a physician, I serve whoever comes to see me to the best of my ability. But this year I have had to pay extra attention to the fact that so many people have already made up their minds about the nature and severity of the pandemic we are living with. If they don’t believe the country’s top experts, they are not likely to believe in me. Still, I try to gently state that we are still trying to figure this thing out and until we do, it’s better to be cautious.

I am starting to read about what some are now calling the Fourth Wave of the pandemic, the mental health crisis this winter may see in the wake of the physical illness we are surrounded by.