Bob Doherty once again has incredible insights – A Tale of Two States
What is wrong with Massachusetts? In the views of these internists, Massachusetts promised the newly insured that they would have access to a doctor, something that it could not deliver on, when the state is experiencing the same hemorrhaging of primary care physicians happening everywhere else.
A new Health Affairs study backs them up. It found that Massachusetts "has sustained gains in insurance coverage and access to care stemming from its landmark 2006 health reform and coverage expansion. However, some of the early gains in reducing barriers to care and improving the affordability of care had eroded by the fall of 2008, roughly two years after the Bay State began implementing its reform." Specifically, "about one in five adults in Massachusetts reported that they were told that a doctor’s office or clinic was not accepting patients with their type of coverage or was not accepting any new patients. These problems were reported for both primary and specialty care (66 percent and 56 percent of those reporting such problems, respectively.)"
Universal coverage is highly desirable, however, for success we must also have physicians to see the patients. We cannot really do it "on the cheap" because physicians have other options. I do not believe that we can "force" physicians to participate, because they can change their style of practice. We need outpatient physicians in large numbers. This change will require major adjustments in incentives.
"If lawmakers sign off on closing the health insurance program for children whose families make too much to qualify for Medicaid, California would be the first state in the nation to close the popular program. Begun in 1997, the program, known as S-CHIP, reimburses states at a higher rate than for Medicaid to deliver health insurance to children and teenagers. With the cuts to Medicaid, the state would probably increase its number of uninsured people by nearly 2 million, the California Budget Project says."
This, just four months after President Obama proudly signed into law an SCHIP extension that was supposed to cover four million more kids nationwide.
Health care costs money. Soon the ACP will release a position paper on costs. I cannot talk about the position paper at this time, but I will say that this paper does look at the health care system in a broad view.
We clearly have enough money in the system. I believe the money could be used much more effectively. I have read articles about decision making under conditions of limited resources for over 25 years. We are there and we must make brave decisions. Of course, I have little faith in politicians ability to be brave.
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In my area of Illinois, only an FP residency accepts new Medicaid patients. Outpatient office visits for a 99213 pay $32, including the $2 copayment. ER visits have no copay for Medicaid patients. I can track patients by health coverage, and my Medicaid patients have a 4 times greater likelihood of not showing up to visits and have 2-3 times more phone calls to the office than my privately insured patients.
I don’t accept new Medicaid patients, outside of ER follow up call. Most of the new ones from the ER don’t show up. Illinois tried an All Kids with expansion to All Families, without success, by trying to assign primary care doctors to the patients for a $2 a month capitation average. Most patients still use the ER and don’t see their assigned primary care providers.
Old Russian saying…You can tell same lie 1000 time but not change truth!
Difference between USSR Communist media and USA “mainstream media”
In Russia government make media say what they want – even if lie.
In USA “mainstream media” try make government what they want – even if lie..
…..eventually they become same thing?!
Do we really want someone who can not even show his own birth certificate try “reform” healthcare
I Igor produce Obama Birth Certificate at http://www.igormaro.org
It takes both coverage (health insurance) and access (enough PCP’s) to make the system work. Any reform needs to address both issues. Many of the universal access people forget about the access side of the equation. My biggest fear is that congress will take the easy fix and just expand Medicare to cover the uninsured and the system will implode after a couple more years as access to primary care declines. The system will be unsustainable unless they focus on the inputs to the problem that drive costs – 1. decreasing the numbers developing chronic diseases which will require major public health initiatives, and 2. decreasing the need for specialty referrals and unnecessary procedures (e.g, MRI’s & coronary stents) by focusing on primary care and prevention.
An example for stents: We had a CME given by a cardiologist last week on cardiac rehab. He flipped up a slide and said “Here is a study most of us cardiologists don’t want to become widely known.” It was a study showing that putting a patient in cardiac rehab was much better than angioplasty for stable angina (88% event free vs. 70%). In my area of the country, it seems like almost everybody here gets the stent first, and then maybe cardiac rehab if insurance covers it. The patients demand it and the cardiologists are more than willing to oblige.
Our system always covers the stent (and pays very well), but often doesn’t cover the cardiac rehab. It covers the $200 a month prescription for Actos, Byetta, or Januvia, but often does not cover the referral to the dietician that might prevent the need for the $200 a month medication.
Dear Friends:
I agree with everyone here but Igor here.
I have posted on this very subject including a summary of things that have to be done with reference universal insurance and primary care.
I did not want to repeat myself here.
http://healthcare.change.org/blog/view/why_does_controlling_health_care_spending_cost_money
I would appreciate any comments.
Bohdan A. Oryshkevich, MD, MPH
When the Massachusettes ‘Miracle” plan was inaugurated in 2006, it was heralded as a health care crisis panacea. The shine on the promise has tarnished. First, there weren’t enough primary care physicians and now there isn’t enough money. If we can’t get universal coverage (Massachusettes was not exactly universal) right in a small state, shouldn’t we learn from our mistakes and misjudgments before jumping off a higher cliff? Health care reform is a Hydra that has tamed American presidents since World War II. I agree that we desperately need it, but I don’t want our treatment to be worse than the disease. wwwMDWhistleblower.blogspot.com
this is a nice post
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