Our Healthcare Headache – Part 2

“Out of control government spending!” “Fiscal irresponsibility!” “Extravagant government expenditures!” We hear it every day – the droning of pundits and politicians on the national budget: the weight of the deficit is crushing us and we must tighten our belts! No matter which side of the political fence you sit on, we can probably agree that spending in the US is out of control. We are less likely to agree on what to do about it.

Depending upon one’s world view, “entitlements” like Medicare and Medicaid are budget busters to be slashed, while military expenditures and low tax rates for corporations and the wealthy are sacred cows, not to be touched. Spending on the national level is the same as in any household – a matter of priorities. But for the sake of argument, let’s consider cutting Medicare to solve our budget problems. What would that mean exactly? Something called the Sustainable Growth Rate (SGR) is set go into effect at the end of the year. It is a $62 billion “doc fix” that would be paid for by “changes that squeeze Medicare and Medicaid payments to hospitals and doctors and expand the use of generic drugs in federal health programs,” according to The New York Times. Congress has been delaying putting it into effect since it was proposed in 2001 for obvious reasons. If doctors suddenly had to eat a substantial part of the cost of treating Medicare patients, they might drop those patients. When the SGR does go into effect, doctors across the board will see a 21.1% drop in reimbursement rates – an enormous amount. Many doctors can’t afford to treat patients for so little compensation, especially primary-care doctors, who are already financially strapped. Other proposed cuts would reduce inpatient repayments, hospital readmission subsidies, nursing, imaging, medical education, pharmacy and home health services. Even if unintentional, these cuts will have a trickle-down effect which will result in reduction in services for the elderly and disabled.

“I just want to assure [you] we’re not talking about cutting Medicare benefits.” President Obama said this to a town hall audience in Portsmouth, New Hampshire. A “myth that we’ve been hearing about is this notion that somehow we’re going to be cutting your Medicare benefits,” Obama said on Aug. 11, 2009. “We are not.” Well, perhaps not directly. But a person on Medicare who can’t find a doctor to treat him will, in effect, experience a cut in benefits. And any patient who relapses and is refused readmission to a hospital will experience a similar cut. Cuts in services for the elderly may raise no eyebrows in some circles. But people who need medical care and can’t go to a doctor don’t just fade away. They go to emergency rooms for treatment, instead. Getting treated in an emergency room is 3-4 times more expensive than a trip to the doctor’s office, according to the California Health Care Foundation. When hospitals provide emergency care, they absorb millions in uncompensated costs. They must recover that money and someone has to pay for it. People with insurance pay a hidden tax, in the form of higher insurance premiums, higher deductibles, co-pays and out-of-pocket expenses. What’s more, when millions of people use emergency rooms as their only means of healthcare, they don’t receive preventative care for things like weight reduction and smoking cessation. That adds billions to the back end of the healthcare budget for treatment of chronic disease. Health outcomes in the US are already lower than that of other developed countries; cuts to Medicare aren’t going to fix that, nor will they help to balance the budget by cutting overall healthcare costs.

Public discussion about our healthcare system has been reduced to one of dollars and cents. Little is heard about the ethics of the system. What does the system of healthcare delivery in this country say about us?  A report released in 2000 by the World Health Organization said that any healthcare system defined as both good and fair would include the following: 1.) overall good health (e.g. low infant mortality and high life-expectancy) 2.) a fair distribution of good health across population groups 3.) a high level of overall responsiveness 4.) a fair distribution of responsiveness across population groups and 5.) a fair distribution of financing health care (the cost of financing health care is fairly distributed based on ability to pay so that everyone is equally protected from the financial costs of illness). By this definition the US healthcare system is neither good nor fair. It is also, by far, the costliest system of healthcare delivery in the world.

When Medicare was first proposed in 1965, it was to be the first step in providing accessible, affordable healthcare to all Americans. Yet America has never been able to enact universal government health coverage. That’s why today the U.S. is the world’s only industrial democracy with compulsory health insurance for only its elderly. Even in that the system fails our seniors; the program excludes long-term care, dental care and coverage of the catastrophic expenses of chronic illness. Coverage for prescription drugs is inadequate at best. And despite all of this, concerns about the deficit, rather than expanding access and improving care are fueling the calls for reform. Does a country as wealthy as ours have a moral obligation to meet the health care needs of its citizens?  Even if you disagree with that principle, most of us would agree that our current system of Medicare for the elderly and for-profit insurance for everyone else costs too much and delivers too little. And like that old car that we tinker with endlessly but still doesn’t run very well – it’s time to trade it in for something new.


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