crb
05-22-2012, 11:56 AM
http://www.nejm.org/doi/full/10.1056/NEJMp1203247#t=article
Wordy and technical but enlightening.
This is a prime example of rationing by access, when the government cuts payments, patients lose access to care. The only way they can get access is for the government to pass a law forcing providers to provide care, and now WA wants to be able to not have to pay for that care.
So who cares right? Poor people should just go get jobs if they want better care... well... when government forces providers to provide care below cost, it affects the rest of us who might want to use the same providers.
If the compromise measure falters and Washington State's Health Authority goes forward with its nonpayment policy, other states could quickly follow suit. If that happens, the resulting spike in uncompensated care costs will probably accelerate an already alarming national trend in ED closures. Everyone's access to emergency care could be affected.
I like to tell the story about how my home town hospital, which is in a very poor rural area, had to cut OB services for EVERYONE because too many medicaid patients (whom maybe should not have had babies to begin with, but that is another post) were getting care at below cost. By law hospitals cannot discriminate based on ability to pay for emergencies, so since it was illegal for them to only offer baby deliveries for people who could pay for it, they had to just opt out of offering them at all.
This sort of thing already happens. Increasing the number of people on medicaid will not fix it, only make it worse. This is why so many people dislike Obamacare and other government expansions into healthcare, it ultimately threatens their family's healthcare access even if they work hard and have or can afford private insurance.
Obamacare's problem is that it did nothing to bend the cost curve down, which is the real problem. You need to identify why medical care is so expensive, and why it increases in price at a rate much higher than inflation, and do everything possible to address those two issues. Only then can you have a conversation about increasing access (which, at that point, could become moot, as you will have made it much more affordable).
Wordy and technical but enlightening.
This is a prime example of rationing by access, when the government cuts payments, patients lose access to care. The only way they can get access is for the government to pass a law forcing providers to provide care, and now WA wants to be able to not have to pay for that care.
So who cares right? Poor people should just go get jobs if they want better care... well... when government forces providers to provide care below cost, it affects the rest of us who might want to use the same providers.
If the compromise measure falters and Washington State's Health Authority goes forward with its nonpayment policy, other states could quickly follow suit. If that happens, the resulting spike in uncompensated care costs will probably accelerate an already alarming national trend in ED closures. Everyone's access to emergency care could be affected.
I like to tell the story about how my home town hospital, which is in a very poor rural area, had to cut OB services for EVERYONE because too many medicaid patients (whom maybe should not have had babies to begin with, but that is another post) were getting care at below cost. By law hospitals cannot discriminate based on ability to pay for emergencies, so since it was illegal for them to only offer baby deliveries for people who could pay for it, they had to just opt out of offering them at all.
This sort of thing already happens. Increasing the number of people on medicaid will not fix it, only make it worse. This is why so many people dislike Obamacare and other government expansions into healthcare, it ultimately threatens their family's healthcare access even if they work hard and have or can afford private insurance.
Obamacare's problem is that it did nothing to bend the cost curve down, which is the real problem. You need to identify why medical care is so expensive, and why it increases in price at a rate much higher than inflation, and do everything possible to address those two issues. Only then can you have a conversation about increasing access (which, at that point, could become moot, as you will have made it much more affordable).