Falling Behind: Americans' Access to Medical Care Deteriorates

[herring_RN]

Falling Behind: Americans' Access to Medical Care Deteriorates

The number and proportion of Americans reporting going without or delaying needed medical care increased sharply between 2003 and 2007, according to findings from the Center for Studying Health System Change's (HSC) nationally representative 2007 Health Tracking Household Survey.

One in five Americans--59 million people--reported not getting or delaying needed medical care in 2007, up from one in seven--36 million people--in 2003.

While access deteriorated for both insured and uninsured people, insured people experienced a larger relative increase in access problems compared with uninsured people.

Moreover, access declined more for people in fair or poor health than for healthier people....

http://www.hschange.com/CONTENT/993/

[RN4MERCY]

Walmart is probably the largest private health provider in the US. Those four dollar scrips have lowered the cost and increased the competition.

The marketplace works boys and girls.

The "marketplace" is a lousy way to distribute health care. And, calling Walmart a health provider is really a stretch; they're in the business of retail sales. Competition? for the healthiest people with the most money is what they're all about. I refuse to shop at a store, like Walmart, that is abusive and disrespectful of workers' rights.

Before you go on extolling the "virtues" of Walmart, you should watch Robert Greenwald's BRAVE NEW FILMS, movie: WAL-MART: THE HIGH COST OF LOW PRICE. It is a feature length documentary that uncovers a retail giant's assault on families and American values. The film dives into the deeply personal stories and everyday lives of families and communities struggling to fight a goliath.

http://video.google.com/videoplay?docid=-3836296181471292925

As a nurse, I don't want to shop in markets where people are going in to seek health care. What if that headache is meningitis? What if that rash is the measles? What if that cough is tuberculosis? How terribly sad and inconvenient and devastating the consequences for the unsuspecting pregnant woman, or her elderly grandmother, or her college-aged brother.

The high cost of low price is a public health disaster waiting to happen. Consider that Canada was able to prevent a pandemic of SARS because of their national health system and public health surveillance. Do you really think a retailer is going to be forthcoming with disclosure about a patient with a contagious disease that spawns an (think Typhoid Mary) outbreak? If an announcement about public risk of exposure to a contagious disease would hurt their sales, I don't think so! Profit at the expense of the sick and injured should not be tolerated in a just society.

We deserve a national health plan that extends MediCare benefits to all, based on the single-payer model. Shouldn't everyone be able to get the medications they need? Prescription drug prices are lower in countries with a universal health plan, because the government is able to use its bulk purchasing power to negotiate lower drug prices on behalf of all people.

According to Dr. Marcia Angell, Physicians for a National Health Plan, (former editor of the New England Journal of Medicine),

We live in a country that tolerates enormous disparities in income, material possessions, and social privilege. That may be an inevitable consequence of a free market economy. But those disparities should not extend to denying some of our citizens certain essential services because of their income or social status. One of those services is health care. Others are education, clean water and air, equal justice, and protection from crime, all of which we already acknowledge are public responsibilities. We need to acknowledge the same thing for health care. Providing these essential services to all Americans, regardless of who they are, helps ensure that we remain a cohesive and optimistic country. It says that when it comes to vital needs, we are one community, not 280 million individuals competing with one another."

http://www.pnhp.org/facts/statement_of_dr_marcia_angell_introducing_the_us_national_health_insurance_act.php[/url]

[Katie82, RN]

The purchasers of DM/CM services want to see a return on investment and do not want to see the insured fully in control of a situation. It's going to be interesting to see what the boomers do with DM/CM services. I really think that boomers will end up having alot of authority in getting the services they want.

I will also find the reactions of the Boomers interesting. I spent time managing the current Medicare Population, and my greatest challenge is that they often trust everything but their own judgement. My goal has always been to insure that my patients make informed decisions, but I find the older seniors to be extremely passive when it comes to medical decisions. The old "I don't worry about that because my doctor is taking care of me" drives me crazy. To that I always reply that their in a managed care enviornment, their doctor does not have time, they need to take care of themselves. I think the Boomers are much less trusting, much more informed, and will be much more in control. Good for them, will make my job a little easier.

[Katie82, RN]

Thanks, Herring. I believe we can do better in America, and that we must end this injustice. A single-payer system of health care would put those precious dollars to work providing health care and medicine to all who need it.

Unfortunatly, this would probably not be the case. CMS and HHS outsource a lot of their administration now with just Medicaid and Medicare. They do this because they are reluctant to be totally imersed in the health care business. A single-payer system would result in even more outsourcing and a huge bureaucracy to monitor it. Insurance companies, which have been in the business for decades, will simply evolve from payees to administrators and I'm not sure we would be better off.

[herring_RN, ASN, BSN]

I hope the boomers will vote and lobby to stop this epidemic of outsourcing.

That was part of the bill that passed congress:

In a floor session electrified by the appearance of Sen. Edward M. Kennedy, the critically ill Massachusetts Democrat, the Senate voted Wednesday to stave off a cut in Medicare fees to doctors who treat seniors, military personnel and their families and others....

...Bush and many Republicans opposed the bill because the funds to prevent Medicare reimbursement cuts would come from more than $12 billion set aside to pay private insurance companies that offer Medicare Advantage, including Blue Cross, Blue Shield and Humana. ...

http://www.latimes.com/news/nationworld/washingtondc/la-na-medicare10-2008jul10,0,5100401.story

[RN4MERCY]

Unfortunatly, this would probably not be the case. CMS and HHS outsource a lot of their administration now with just Medicaid and Medicare. They do this because they are reluctant to be totally imersed in the health care business. A single-payer system would result in even more outsourcing and a huge bureaucracy to monitor it. Insurance companies, which have been in the business for decades, will simply evolve from payees to administrators and I'm not sure we would be better off.

I don't think there is a more heinous, complex, and wasteful bureaucracy in the United States, than that of multiple insurers, who consider it an acceptable business practice to delay and deny payment/approval for treatment to make a profit.

When you talk about outsourcing administration, don't you mean things like e-mail/communication systems, IT network maintenance, and payroll services?

The cost and coverage of health insurance is a huge problem for many working Americans. More employers are dropping group plans altogether, and throwing their employees at the mercy of the private market. As much as a third of every health care dollar going through private health insurance goes to pay for their overhead, profits, marketing costs and excessive CEO salaries. In real numbers, out of $500,000 worth of insurance dollars, $166,666 goes to overhead, marketing, and profit!

MediCare is a single (government) payer national health insurance system, that has a widely reported administrative cost of 3%. By comparison, it's really very efficient and fair. It can be improved upon and expanded to cover everyone, with the savings that would be realized by eliminating the waste and shame of for-profit insurers. An equitable and fair tax contribution that will eliminate the need for co-pays and deductibles.

Doctors on average have to hire 2.5 staff people just to deal with the conflicting paperwork, rules and bureaucracy of private health insurance. No other industrial country allows private health insurance to play a dominant role in the health care system. A prime benefit of a national single payer system is that it would save several hundred billion dollars annually by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Doctors and hospitals would be freed from the burdens and expenses of paperwork created by having to deal with multiple insurers with different rules - often rules designed to avoid payment.

Many Americans are under the delusion that we have "the best health care system in the world," or that we provide the "best medical care in the world." That may be true at at several top medical centers. However, the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.

I'm very sure that we would be much better off with a national health plan. The evidence is pretty clear and convincing. The US ranks dead last in preventable deaths, out of 19 other industrialized countries--noteworthy is the fact that the US is the only country in the study without a single payer system. Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th.

The government does many things well, and it's up to us to hold our elected officials accountable; healthcare should be a right, an entitlement based on medical need, not on an individual's ability to pay! Australia, Canada, Germany, New Zealand and the United Kingdom - on most measures of performance, including quality of care and access to it, outrank us. We can most certainly do better.

[herring_RN, ASN, BSN]

young mom, wife's coverage costs as much as mortgage

http://www.calnurse.org/media-center/press-releases/2008/october/young-mom-wife-s-coverage-costs-as-much-as-mortgage.html?print=t

[Katie82, RN]

Many insurers try to help the Medicare population "manage" their care, but the seniors want full authority in deciding what they want which is understandable. Insurers tend to like to dangle things on a rope. The purchasers of DM/CM services want to see a return on investment and do not want to see the insured fully in control of a situation. .[/

One of the major causes of health costs today is that folks will not take responsibility for their own care. I have worked in case management for several years for three different companies and I can tell you that while ROI is a goal, my first goal (and always with the blessings of my employer) is to provide the patient with better healthcare. Bottom line, a healthy patient costs less. Don't beat up the insurer, the patient also benefits. The comment I receive more often than any other is "Oh, I don't worry about my lab results, my doctor takes care of everything..."I agree that the boomers will be in better control of their own situation, but it will be because they are better informed, and don't depend on their doctor to take care of everything for them.

[Katie82, RN]

Thanks, Herring. I believe we can do better in America, and that we must end this injustice. A single-payer system of health care would put those precious dollars to work providing health care and medicine to all who need it.

Do you think the government is going to do all the work if we have a "single payer" system? Medicare is a classic example. CMMS outsources most of the administrative work for Medicare - even the 1-800-MEDICARE information line is outsourced. CMMS has known for some time that Managed Care is the only alternative to keep Medicare solvent, and they are moving in that direction. The Advantage Plans are the first step, but it will come system-wide. The 12/17% that you note simply replaces the surcharge CMMS now pays BC/BS and other contractors to take care of administration now.

My in-laws were a classic example of the waste in Medicare- they doctor-shopped at will. Don't like the answer one doc gives you? Find another. My father-in-law saw 8 different doctors within a six month period for constipation. Answer was always the same: change your diet. When I think of all the money they cost Medicare, and themselves with the 20% co-pays over the last 10 years of their lives, I understand why Medicare is in trouble. Some think of this as being in control of your healthcare, I call it an irresponsible waste of money.

[Katie82, RN]

[color=#394b6b]health care marketplace | u.s. spends more than twice as much on health care per person than most other industrialized nations, ranks last in preventable mortality, study finds

the u.s. spends twice as much on health care per capita than most other industrialized nations but ranks lower than those nations on a number of criteria, according to a report released on thursday by the [color=#394b6b]commonwealth fund, the [color=#394b6b]new york times reports (abelson, new york times, 7/17). ...

[color=#394b6b]http://www.kaisernetwork.org/daily_reports/rep_index.cfm?dr_id=53347

i believe every word of this, but is this always the fault of the system. for most folks, "access to care" depicts images of doctors refusing to see patients, or insurance companies refusing to pay. a very large part of access to care lies with the patient themselves. the patient who only goes to the doctor when they are ill because they don't have time for "that preventive stuff", the patient who doesn't follow treatment protocols or keep appointments with specialists. this is also an access to care issue, but few people consider that. part of our problem is that so many americans don't consider their health care a priority until something goes wrong, then they complain that it isn't being fixed quickly enough. i remember a series of articles in my local newspaper a few years back. 28 year old woman with cervical cancer dying and complaining about access to care. part of the story was that she had a 10-yr history of a hpv pap that she failed to follow-up. she admitted she was busy and careless for ignoring all the people within the medical community who were trying to care for her. still came out sounding like an access to care issue, and i don't know how she could blame that on anyone but herself.

[Katie82, RN]

http://video.google.com/videoplay?docid=-3836296181471292925

As a nurse, I don't want to shop in markets where people are going in to seek health care. What if that headache is meningitis? What if that rash is the measles? What if that cough is tuberculosis? How terribly sad and inconvenient and devastating the consequences for the unsuspecting pregnant woman, or her elderly grandmother, or her college-aged brother.

http://www.pnhp.org/facts/statement_of_dr_marcia_angell_introducing_the_us_national_health_insurance_act.php[/url]

And you think you don't run into these people in your own market?

[Katie82, RN]

When you talk about outsourcing administration, don't you mean things like e-mail/communication systems, IT network maintenance, and payroll services?

No. CMMS pays BC/BS to administer the program. When a Medicare recipient calls Medicare about a bill or premium dispute, they are actually dealing with BC/BS. They manage the premiums, pay the bills, and send out those annoying "This is not a Bill" statements. THe Pentagon also used BC/BS to administer CHAMPUS before the advent of TRICARE. Outsourcing has been the name of the game for decades. I lived about 10 miles from CMMS Headquarters in suburban Baltimore (right next door to SSA Headquarters). I have many friends who work for CMMS. They are in the business of Policy and Regulation, they have worker-bees for the actual grunt work.