1. Health care insurance is not health care delivery.
This is not only true of the repeal proposal, it is true of the ACA as well. The idea that people with insurance can get timely care is simply not true. According to a report released last month:
Researchers at Merritt Hawkins, found the average wait time for:
· A cardiologist was 21.1 days in large markets and 32.3 days in mid-sized markets;
· A dermatologist was 32.3 days in large markets and 35.1 days in mid-sized markets;
· An OB-GYN was 26.4 days in large markets and 23.1 days in mid-sized markets;
· A family medicine doctor was 29.3 days in large markets and 54.3 days in mid-sized markets;
· An orthopedic surgeon was 11.4 days in large markets and 15 days in mid-sized markets.
The VA Office of the Inspector General reported, based on a sampling last month that 36 percent of appointments for new patients had wait times longer than 30 days. OIG estimated the average wait time for that 36 percent of appointments was 59 days. According to the report, an estimated 20,600 medical appointments in the VA had wait times greater than 30 days.
2. 53 different systems of eligibility and service menus makes no “business” sense.
Let’s begin with the assumption state legislatures are the best places for making decisions about our health. The GOP plan reduces by 30+% overall funding for health care and then splits the monies up to the states and territories, we don’t know how that split will be calculated (population under 65 / Medicaid enrollment / or political prowess). These states are working with smaller federal support and smaller budgets. If they are already cutting elementary education imagine what they will do for those who live in poverty.
But they are not alone in making the decisions. The “insurance” approach to health care also involves the State Insurance Commissioner. The insurance commissioner is a state-level position in all 50 states. The duties of the position vary from state to state, but their general role is as a consumer protection advocate and insurance regulator. The position is elected in 11 states and appointed in 39.
In today’s business environment, it is common for large and small companies alike to expand across state lines or hire remote, out-of-state workers. The health care coverage will differ from state to state. If you are pro-business think about this model.
3. Physicians are in short supply and thousands are at risk of deportation.
A study by the Association of American Medical Colleges, released in March, predicts a U.S. shortfall of physicians somewhere between 40,800 and 104,900, due to factors such as population growth, an increase in the number of aging Americans and the retirement of practicing doctors.
In rural America the irony of Trump’s strong support from these regions, is that they are extremely dependent on a decades old program established by a Senator from North Dakota to attract physicians from outside the US to meet the need for care in rural communities.
Recent research by economists at Harvard and MIT counts over 7,000 physicians in the United States who are from one of the countries listed in the second travel ban. The potential for loss of physicians in rural states and small towns—areas that are already suffering from a lack of access to quality healthcare—can have a substantial impact on the number of available physicians. Add to this the number of undocumented individuals believed to currently be attending medical schools and residency programs in the United States, and the negative impact continues to grow on the access to healthcare.
4. The Cost of Care
True costs are guessable at best. We do know, ours is the most expensive health care in the world. We also know it represents 1/6th of our economy. We recognize but never talk about the most expensive of care… Some estimates are that one of every seven dollars spent for health care are spent in the first seven days and last seven days of life, on care for a patient who is not participating in the decision making process.
If we start to talk about these ideas, we might just arrive at a very different place.
