May 10, 2010
Insurance Doesn't Mean Health
Duncan Currie explains why it is speculation to assert that increasing health insurance coverage will mean improving health and decreasing avoidable deaths (subscription required). For the most part, it's a problem of separating data points. This part, however, moves beyond the immediate question and gives some reason to worry about the effects of ObamaCare, moving forward:
Here's another reason we should not expect the landmark bill to yield major health gains: A hefty chunk of the newly insured under Obamacare — anywhere from 15 million to 18 million people, according to projections — will rely primarily on Medicaid for their insurance. Unfortunately, the fact that Medicaid reimburses participating providers at low rates has made it increasingly difficult for recipients to find doctors. In a 2008 survey, only 40.2 percent of physicians told the Center for Studying Health System Change that they were accepting all new Medicaid patients, and more than a quarter (28.2 percent) said they weren't taking any. It can be even harder for Medicaid patients to locate dentists.And yet this is the program that will soon be flooded with a massive wave of new enrollees. Dr. Edward Miller, dean and CEO of Johns Hopkins Medicine, has written that "without an understanding by policy makers of what a large Medicaid expansion actually means, and without delivery-system reform and adequate risk-adjusted reimbursement," Obamacare "will have catastrophic effects on those of us who provide society's health-care safety-net."
One foreseeable government "fix" will be a requirement that doctors not consider the type of coverage that potential patients have, forcing them to take all comers for whom they have room in their schedules (probably with regulations of how many patients doctors must accept). If that comes to pass, established doctors may just stop taking new patients at all, they might charge privately insured patients even more, or they might just quit the field.
The following was posted by a guy on another discussion forum I frequent. It's an excellent example, perhaps even a mild one:
Socialized medicine is great!!!
As long as you don't get sick or injured!
First, a little background. I got laid off and was unemployed for about four months. I was forced to go on MA Health until I found a new job. In December, I finally found a job, but it was only part time and they don't offer health insurance. I was then forced to keep the MA Health.
At the end of January, I fell on some ice, dislocated my right ankle and broke my right leg. I had to get surgery on my ankle and had screws put in to hold everything together. At the end of March, once everything had healed, I had a second surgery to remove the screws. April 3rd, I went to the pharmacy to fill a prescription, only to find out that my insurance had been cancelled. Mind you, I still had stitches in my ankle from the surgery.
I tried to call MA Health, only to find out that they're not open on the weekends. The following Monday, I called and found out that they recieved a notice in January from MA DOR saying that I was working. They supposedly sent me a "Job Update Form", which I never got. Since I never received it, I never filled it out and never sent it back in, so they decided to cancel me without any further notice. I explained to the woman my predicament about just having another surgery and still having stitches in and everything. She said that she would re-mail the form to me, and once I fill it out and return it, that they would expedite my renewal.
I got the form in the mail, filled it out and sent it back. About a week later, I called them to see if it had been re-activated yet. They said that I had been approved, however I needed to go online, enroll in the insurance, and then it would be activated on May 1st. I explained to her the predicament I was in, and told her how the other woman I had spoken to said that they would expedite it for me. She said unfortunately they can't do that, that all MA Health enrollments get activated on the first of the month. I ended up having to take the stitches out myself.
On Friday April 31st, I was sitting down in a chair, and because my right ankle was still very sore, I had all my weight on my left leg. I got about halfway down, when I got a sharp pain in my left knee. The next day, it was extremely sore and swollen, so I ended up going to the emergency room. The ER Doctor told me that I had torn a ligament in my left knee, right under my knee cap, and gave me a prescription for a knee brace. When I got home, I called around to see where I could go to fill the prescription that would take my insurance, and found that the only place around was closed on the weekends.
Last Monday, I went to an Orthopedic supplier to fill the prescription. They explained to me that with MA Health, you need to have the diagnosis written on the prescription (which it wasn't), and that they needed to submit it to the insurance for pre-approval, which usually takes 72 hours. She called the ER to have the Doctor send over a new prescription, only to find out that he went on vacation, and wouldn't be back for two weeks. She then decided to write the diagnosis on the prescription herself, and submit it.
I called them last Thursday to see if I had gotten approval yet, and they told me that they haven't heard anything back yet, and that if I don't get a call from them on Friday, to try calling them on Monday. I just got off the phone with them, and they said that I finally got approval, but the Nurse that does the knee brace fittings was booked up, and the earliest I could get in to see him would be on Thursday afternoon.
I think it's great that since the State Insurance Program works SO WELL in Massachusettes, that they decided to implement it for the rest of the Country!
Posted by: BobN at May 10, 2010 3:46 PMState of Hawaii is exempted from the national health-care bill “Obamacare” because it would water down the state enacted health-care reform that took almost 30 years of tweaking to get to where it is now.
Hawaii is the only state in the nation that is exempted from Compulsory Employment Based Health Insurance Federal ERISA provisions in 1974.
The Hawaii Prepaid Health Care Act of 1974, which requires businesses to provide health insurance to employees who work more than 20 hours a week, has long been viewed by national health-care experts as progressive legislation that has kept the number of uninsured well below the national average.
Of the approximately 1.2 million state-wide population about 98% are covered with health insurance and the other 2% are either covered under the State Health Insurance Program (SHIP) or the unemployed not insured poor are addressed through an expanded and generous Medicaid.
Doctors and health-care facilities in Hawaii aggressively promote individual health screenings and regular check-ups. My health-care/dental/prescription drug insurance actually dropped $100/mo. verses the same coverage cost in RI.
Hawaii is the only state in nation closest to providing universal health care to entire state population and has one of the longest living, healthy and less stressed populations in the nation.
BobN,
I have another story. My friend is a diabetic. He is unemployed, has exhausted his unemployment benefits and has no health care. He knows that there are insulin types that he could be using which would work better for his situation, but he can't afford them. So the best he can do is to treat himself with an inferior grade of insulin. He hustles odd jobs to scrape up the cash for his illness. He's still alive, but having problems with eyesight, and deteriorating tissue on his hands and feet. If he were Canadian, he'd have no problem. If he were Cuban he'd get better care. If he were French or Italian or German or English or Chinese, he'd get better care. Your story is sad, but it proves nothing. For every socialist bogey man story there are millions of our citizens with out medical insurance who can tell sadder stories.
OldTimeLefty
OldTimeLefty,
If your friend were a resident (6 mo to establish) in State of Hawaii he would be taken care of.
Posted by: Ken at May 12, 2010 2:41 AMThanks Ken,
The story resonates with you, but not with the likes of the BobNs of the world who don't see the less fortunate among us. The guy is Marie Antoinette in drag.
OldTimeLefty
OldTimeLefty,
Does not matter!
Hawaii does not throw anybody under the bus.
If he can afford some percentage payments then he would be taken in as a non-resident but then, he has to get here first and there is a move starting to take hold to provide one-way tickets back to mainland because of facilities overload by mainlanders who see paradise as a savior blocking locals who also need the help!