Dec 6, 2013
Health Care for All: Why We Need a New Prescription
Posted on Oct 1, 2013
By Scott Tucker
Scott Tucker: President Obama said, on July 22, 2009, “I want to cover everybody. Now, the truth is unless you have what’s called a single –payer system in which everyone’s automatically covered, you’re probably not going to reach every single individual.”
Obama finessed the brutal reality that millions of people, not just “every single individual,” will still not receive comprehensive health care under the Affordable Care Act, also known as Obamacare, which became law in 2010. According to
HealthCare.gov, three key dates are approaching in the translation of this complex legislation into the “Health Insurance Marketplace.” On October 1, 2013, “Market open enrollment starts.” On January 1, 2014, “Health coverage can start.” And on March 31, 2014, “Open enrollment ends.”
Don, what bumps in the road do you expect over the next two or three years, given the stated goals and limits of the ACA? And how many sick and injured people will go over the precipice, especially in working class communities, even if the ACA extends a medical safety net for the young and for people with “pre-existing conditions”?
The trend of the last couple of decades of shifting wealth from middle-income families to the very wealthy will also add to the burden of these families who are already having difficulties meeting other expenses such as funding their retirement accounts and paying for their children’s educations. Many low wage workers will continue to have problems with health care because it will either be paid for with forgone wages for employer-sponsored coverage, which they can’t afford, or their share of plans purchased through the exchanges plans will still be too expensive for them to afford. Worse, many will simply be excused from the mandate and the penalties for not being insured simply because the plans are deemed to be too expensive for them. Thus ACA has granted those with the greatest need for coverage the right to remain uninsured because they can’t afford it.
Theoretically, most of those living in poorer communities should be eligible for Medicaid, but many states have refused to accept federal funds to expand their Medicaid programs. ACA did not provide for exchange coverage for these very poor people because they were supposed to have been covered by Medicaid. These people also fall in the category of those who have the right to remain uninsured. ACA is a sick system that Congress has provided us.
ST: The Los Angeles Times published a September 14 article by Chad Terhune titled, “Insurers limiting doctors, hospitals in health insurance market,” and the reporter wrote, “To hold down premiums, major insurers in California have sharply limited the number of doctors and hospitals available to patients in the state’s new health insurance market opening October 1.”
The article quoted Donald Crane, chief executive of the Association of Physician Groups: “We are nervous about these narrow networks. It was all about price. But at what cost in terms of quality and access? Is this contrary to the purpose of the Affordable Care Act?” How would you compare some of the provider networks, and are we witnessing another conflict between comprehensive public health and the profit motive of private insurers? How do we muddle through this terrain, and is there a better path?
DM: When we speak of provider networks, it is important to distinguish between integrated health systems that are designed to improve efficiency and quality in the delivery of care, and networks contracted by insurers designed to reduce health care spending. Physicians and hospitals joining together to improve patient care is great, but insurers using contracts to limit access to low-cost providers is not in the patients’ best interests. Patients who have free choice of their health care providers would be wise to choose high-quality, integrated systems that can actually save on health care costs by reducing inappropriate care. Patients who will have limited choices in the narrower insurer networks to be offered in the exchanges may not be able to continue to see their current physicians, and may find that the physicians in the narrow networks are not as accessible because they are overbooked or because the approved office locations and hospitals are too far away to be convenient.
As you imply, I think that this can be characterized as a conflict between providing health care as a public service and providing health care as a means to advance the business models of private insurers. Leave policy decisions to private insurers and they will always select policies that will advance their business models as opposed to policies that would provide optimal access, quality and affordability for patients. Having cheaper premiums through narrow network plans is no solution when you can’t get a doctor when you need one, and, when you finally do, you’re left broke because the subsidies for the exchange plans are inadequate to avoid financial hardship for those in need. Single payer would have avoided all of this, and it still can.
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