(This post was originally posted 11/20/17)
(Author’s note: As we enter the last few weeks of the presidential campaign, there are several campaign issues which have been previously addressed in this blog. These include Medicare for All, single-payer healthcare, socialism, school choice and others. In the next few weeks I will be re-posting many of my previous posts on these issues as a review for voters. For this limited time I will be posting five days a week instead of the usual twice a week. These earlier posts will be intermingled with new posts on current topics.)
The American healthcare system is focusing on the wrong problem. Instead of worrying about the impact new legislation will have on health insurance coverage, we should be worrying about providing better access to healthcare treatment.
If you’re wandering alone in a desert looking for water, it will do you no good to discover a Groupon coupon for a free case of bottled water. You can’t drink the coupon and the coupon is worthless unless you can find the water.
That’s why as a doctor I have become increasingly frustrated with the healthcare proposals coming out of Washington. Let me give you a few examples:
Medicaid is essentially free healthcare for those who are eligible. But to carry the analogy further, Medicaid is like having the Groupon coupon for free water in the desert. You may have a Medicaid card that guarantees you free healthcare, but it’s worthless unless you can actually get healthcare treatment.
Medicaid patients have very poor access to healthcare because the reimbursements to providers are so low that few will accept them as patients. Even those who do accept Medicaid usually have very limited numbers of appointments reserved for Medicaid patients. That means long waiting times to receive appointments and therefore to receive healthcare.
This forces Medicaid patients to go to the emergency rooms 40% more often than even the uninsured according to the Oregon Healthcare Experiment study of 2007. This poor access to healthcare is the major reason that Medicaid healthcare outcomes are no better than those without insurance (according to the same study) and worse than those with private insurance in nearly every other study.
In 2014 it was revealed that many veterans were actually dying while waiting to see the doctor at VA Hospitals. Long waiting times for appointments due to the inefficiencies and incompetence of the VA system were costing many veterans their lives. Those who served in our military in defense of our country were being neglected because they had poor access to healthcare.
This problem was identified in the Phoenix VA Hospital but was later found in many other VA hospitals around the country. The VA system is a socialized medicine model and like all socialized medicine systems in the world, it rations care by delaying treatment. Rationing is controlled by limiting access to treatment.
Proponents of the Affordable Care Act (ObamaCare) proudly point to increased coverage of Americans by this healthcare legislation. About 20 million more Americans have coverage since the 2010 passage of this Act.
But about 15 million of those have new Medicaid coverage. However, as discussed above, these newly covered Americans still have an access problem. The other 5 million mostly have ObamaCare exchange policies because large government subsidies have made their premiums affordable.
However, they still have an access problem. They may be able to get in the door of the doctor’s office, and even get an examination, but high deductibles often make it difficult if not impossible for them to get the treatment they need. As a surgeon I know that many of these patients can’t afford the deductibles they need to pay in order to receive the surgery necessary to treat their problem.
(Next post: the solution)