The Little Dutch Boy and Health Care Reform

Dutch BoyRemember the story of the small Dutch boy who just happened to notice that sea water was trickling through a small hole in the dike that protected his town from floods? Realizing that the hole would grow larger if not plugged, the boy poked his finger into the hole. As he sat there, waiting for a passerby who could go for help, his arm began to ache, he became hungry and he wanted to give up and find his friends. Instead he continued to sit there with his finger in the hole. He knew he must be patient and not give up. Finally, after hours, his efforts were rewarded when someone from the village observed the situation and summoned men who were able to seal up the leak. The little boy was a hero.

This story by 19th century American author Mary Elizabeth Mapes Dodge was written for children but provides valuable lessons for all. It teaches the value of decisive action, determination and self-sacrifice on behalf of others. It also warns us that left unaddressed a small problem can become a catastrophe.

I share this story because I think its lessons are worth considering as we listen to some candidates rant about the health care reform law and call for its repeal without offering a better solution.

In 2009, according to the U.S. Census Bureau, the number of Americans without health insurance rose 9.4 percent to 50.7 million people, the highest number since 1987. Not only is the hole in the dyke getting larger, but there are more and more holes (i.e. unemployment, rising premiums, pre-existing conditions, looming Medicare and Medicaid cuts, and limits on coverage). We are already experiencing a flood that, if left unchecked, can destroy our health care system, economy, and even the very lives of our citizens.

On September 23, a number of holes were plugged when the following provisions of the federal health reform law went into effect.

  • Insurers are no longer able to cancel individual coverage if a customer gets sick.
  • Insurers are no longer able to bar children with pre-existing conditions; the same rule goes into effect for adults in 2014
  • Young adults up to age 26 are able to remain on their parents" health insurance policy, as long as the adult child does not have coverage availability from his or her own employer.
  • New plans sold after September 23 must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance.
  • Insurance companies are prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays.
  • Medicare patients will receive a $250 rebate on their out-of pocket expenses this year and, over the next decade, the co-pay on prescriptions will decrease significantly.
  • Prior authorizations for visits to obstetricians and pediatricians will no longer be required.
  • Insurance plans must cover the cost of immunizations.
  • Insurance plans cannot impose prior-authorization or increased cost sharing for emergency services, whether provided by in-network or out-of-network providers;


These provisions are already helping to keep people from being sucked from the insured pool to the uninsured pool. They are also helping previously uninsured persons get coverage. But the best is yet to come because the new law calls for more extensive repairs between now and January 2014. As a result 500,000 of the 760,000 currently uninsured South Carolinians will finally have health coverage by 2014. These repairs are being phased in to keep the repair bills from adding to the federal deficit. However, opponents still complain about the cost of repairing the system and even call for repeal of the law.

Whether we oppose or support the health reform bill as the solution, we all need to understand the consequences of doing nothing to stop the flood. Like the little Dutch boy, we can't just pull our finger out of the hole in the dike by undoing what has already been done unless someone comes up with a better fix. So far, no one has.

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