The greatest healthcare in the world is worthless to someone who has no access to receive it. We take for granted that we can get healthcare whenever we need it – until we can’t.
The importance of access to healthcare cannot be overstated. It is the unspoken issue that separates our U.S. healthcare system from socialized medicine systems in countries like Canada, Great Britain, and Sweden.
Most politicians like Bernie Sanders, Hillary Clinton, even Donald Trump, want to talk about providing healthcare to “everyone who needs it.” But what they mean is the government should pay for it – whenever it is actually provided. You will never hear them discuss the word access.
The reason they won’t discuss access is because that is what is sacrificed in the interest of government control of healthcare costs. In every socialized system in the world, access to healthcare is a problem. In order to control costs, access is delayed. The problem of access has gotten so out of control that in each of these countries the government is now paying private healthcare providers to treat public patients that the system cannot handle.
In our own country we see this problem most dramatized in the VA system. Two years ago we learned of the scandal at the VA Hospital in Phoenix where veterans were actually dying while they waited for appointments to see the doctors. The subsequent investigation revealed 57,000 veterans had been waiting more than three months for an initial appointment and another 64,000 veterans had requested an appointment over the past decade but weren’t even on the waiting list. These people had either fallen through the cracks of the system or had been kept on secret lists designed to make the facilities appear more efficient than they were.
Under bipartisan pressure, VA Secretary General Eric Shinseki was forced to resign. Although this soothed some of the political wounds the Obama administration was nursing, it is unlikely to make a significant difference in the functioning of the VA Hospital system. Recent reports continue to show the perverse bureaucracy of the VA persists. (Ironically, bipartisan attempts in Congress to pass legislation that would make it easier to fire or demote VA senior executives was blocked by Vermont Senator Bernie Sanders.)
Improving access in the VA system will be a major challenge impeded by the government bureaucracy. Any further slide down the socialist ladder toward single-payer healthcare will make access even worse. Access is always threatened when the government is given greater control of healthcare.
To improve access in the system as it is today will require innovative thinking and restructuring of government-run programs like Medicaid and Medicare. Medicaid suffers from the worst access problems because payments to doctors are unacceptably low preventing most doctors from participation in the system. With the cost of providing care escalating due to government-mandated regulations and ObamaCare, most doctors lose money when treating Medicaid patients.
Economist John C. Goodman, contributor to Forbes, points out another access problem in the VA system. Veterans often prefer seeing private physicians to avoid long wait times to get an appointment with VA physicians. But the prescriptions written by those private doctors can’t be filled at the VA pharmacies to save them money without getting the prescription re-written by a VA physician.
Goodman suggests the rules be changed to allow veterans to fill prescriptions from private doctors at the VA pharmacies. To defray the costs brought on by the increased demand, a nominal extra charge of 10% could be assessed. Most veterans would likely consider this a reasonable expense and access to physicians and medications would improve.
Walk-in clinics is another example. Allowing nurse practitioners to staff these clinics following computerized protocols developed by physicians lowers the cost of primary care medicine. If Medicare and Medicaid would just pay the market price for these services, healthcare access would improve, especially for the poor and senior citizens of our country. To dampen the fears of government bean counters, a nominal out-of-pocket charge could defray additional expense without imposing an undue burden on the patients.
Lastly, I believe many physicians would accept Medicaid patients if the government would allow them to collect a nominal co-pay from the patients to supplement the low re-imbursement rates. Most patients would be willing to pay an additional 10 to 20% if it improved their access to healthcare.
But since this is currently illegal, doctors cannot ask for such payments and patients are often left with fewer choices than even the uninsured. Most likely this explains the alarming studies that repeatedly show Medicaid outcomes are worse than the uninsured.
It all comes down to access. Without it, the best medicine in the world is useless.