Do you remember the story of the little Dutch boy who plugged a
dike with his finger? It's a fitting metaphor as we continue
to discuss healthcare reform.
As told in the story, the boy noticed 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
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
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
On September 23rd, a number of holes were plugged when the
following provisions of the federal health reform law went into
- 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 23rd 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.
However, 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
(my home state) 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
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
So far, no one has.
More information on healthcare reform can be found at
Thornton Kirby has served as President & CEO of the
South Carolina Hospital Association since 2005. He blogs for the
South Carolina Hospital Association at http://scha.org/thornton-blog. Connect with him
on Twitter: @ThorntonKirby.