West Virginia Man Sees Both Sides of Healthcare

West Virginia native Tom Sims has seen both sides of healthcare.

For most of his professional life, the Charleston resident worked in the field of healthcare. Most recently—like many Americans—Sims has experienced first hand the pressing need for more affordable healthcare.

Unlike most Americans, Sims is doing something about that. He recently traveled to Washington, D.C., as part of a delegation of AARP volunteers who went to Capitol Hill to campaign for much-needed reforms.

“I’ve seen it from different sides,” Sims said. “We can have a much better system than we have now if we can address the escalating costs, waste, and abuse. The money saved can be spread out to even the playing field for everyone.”

Sims’ father was a primary care physician. Sims, himself, has worked as an administrator in two health clinics. He also worked in four hospitals. In March, he retired after 16 years as Director of Health Promotion and Chronic Disease for West Virginia’s Bureau of Public Health.

Retirement has a different rhythm, said Sims, who misses the structure offered by going to the office daily. In an effort to keep busy—beyond his weekly golf game with friends—Sims volunteered to aide AARP in its campaign for health reform.

“I’ve been a member since I was 50; mostly to take advantage of the discounts and information services,” he said. His commitment to AARP changed as he worked with AARP West Virginia staff member Angela Vance to bring health reforms to his native state.

The tipping point was Sims own experiences as a healthcare consumer. His health is good, but—unfortunately—that’s not the case for his wife, Claudia. She has had heart bypass surgery. Claudia is also diabetic and suffers from severe arthritis.

The couple’s insurance coverage, through the state, is good, but that only alleviates Sims’ concerns, it doesn’t eliminate them. The couple’s medical costs are mounting. Treatment for Claudia’s conditions requires her to take 13 prescription drugs and some of those drugs are not available in less expensive generic form. In addition to the expense of prescription drugs, there’s other costs, such as the co-pay the couple pays on every visit to the doctor’s office.

Greater concerns lie ahead. Neither Tom nor Claudia is of Medicare age, but it’s approaching. Sims said unless something is done soon, when the couple does become eligible for Medicare, they’ll face higher costs for prescription drugs because of the donut hole.

“Healthcare has some great people working in it,” Sims said, “but they’re burdened by the current system. I don’t fault nurses or doctors or caregivers, but there is so much out there with a cost to us with no value added.” An example, Sims said, is the role that insurance companies play as middle man, resulting in increased administrative costs for doctors and hospitals.

“The idea that healthcare costs are rising faster than the rate of inflation, that’s the real problem,” Sims said. “It’s not the entire problem but a large part of it.

“We have to increase access to healthcare,” he said, “yet keep the rate of growth of costs reasonable.”

Sims is hopeful that change is on its way. “I definitely think the healthcare system is going to be improved, but I’m doubtful we’ll get everything we need. We’re up against some very strong opposition.”

Sims plans to continue to work toward quality, affordable healthcare for all Americans in his role as a volunteer for AARP.

“I applaud AARP for what it is doing to make a difference in this debate,” Sims said. “I value AARP. Its message is honest.”