Why the new healthcare law will fail miserably (part 4):
1. It totally fails to address the real problems in the US healthcare system.
a. Over-indulgence by the insurance companies.
b. Unsustainable growth (in this case, by Universal Coverage).
c. No tort-reform on law suits.
(read prior posts to catch up on these points)
d. No accountability for the Publically Insured.
One point that has been relatively untouched by the media and the discussion groups that I have seen is the differences in responsibility and accountability between privately and publically insured patients.
My insurance has a co-pay and a deductible. I can look at two different physicians or two different tests (as courses of action) and I have to decide which is best for me medically, but I ALSO have to consider which is best for me financially. I will have to pay 20% of the bill, so there is a substantial difference between a Physician who charges $100 for an office visit -vs- one who charges $600. Or there is a tremendous difference between an Ultrasound which costs $600 -vs- the MRI that costs $6,000. I am forced to weigh the potential benefits as compared to the out-of-pocket expense. i.e. the MRI may not statistically provide better information.
The same is not true for Public Aid. At *best* most PA plans have a flat co-pay per visit. So, if one doc charges $100 for the office visit and recommends a $600 ultrasound, there is no reason for the publically insured patient to choose that route over the $600 office visit and $6,000 MRI, because there is no vested financial interest on the part of the patient. They pay the same amount (usually nothing).
It is a fact that fewer publically insured patients maintain a Primary Care Provider and get regular preventive care. It is also a fact that more publically insured patients use the Emergency Room as a Primary Care Facility. The reason is not a stretch. There is no financial deterent to someone who pays for no part of the visit. I look at paying 20% of a $200 office visit as a far superior choice to paying 20% of a $2,000 ER visit. If there is no financial accountability, why would anyone care?
Unfortunately, the new healthcare law ceases to address this, very real, problem. I work at an inner-city hospital, where 8 or 10 hour ER waits are standard. Most inner-city ER's run less than 20% privately insured. Additionally, it is estimated that less than 50% of these ER visits are actually emergent. The ER's are plugged up with people who choose to use them rather than to establish care with a PCP. It is my experience, that when these patients are stabalized and set up with a PCP, the vast majority of them will NEVER keep the PCP appointment. In clinics that I have managed, Publically Insured "New" patients have almost a 40% no-show rate...over 400% more likely to No-Show than a Privately Insured "New" patient.
How will universal insurance affect this kind of situation? I think our best indicator would be to look at Massachusetts, since it is the only state that already mandates Health Insurance. In MA: preventive visits are down, ER visits are up. Ironically, the ER visits are not up solely because of Publically insured...they are also flooded with Privately Insured patients who can not get in to see a PCP, because the PCP offices are backed up for MONTHS due to the mandatory, unsustainable growth (see previous post). This has now given Massachusetts the distinction of having:
1 the slowest care in the country,
2 the highest percentage of ER visits, and
3 the most expensive healthcare in the US. Look these stats up on the internet, they're scary.
Thankfully, the rest of the country will soon be modelled after MA, so they won't be alone.
I have yet to see the positive side of this law....
No comments:
Post a Comment