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The great Massachussetts health care experiment has yielded mixed results. And in the real world small businesses are choosing between firing employees or cutting out health care benefits. The combination of dynamics suggest that any government health care "reform" will likely lead to a whole new set of problems, which are already evident and growing.
Although Massachussetts has the lowest number of uninsured people, there has been little change in access to care or any decrease in emergency room use, according to a report from the Urban Institute. The New York Times reported: "Massachusetts continued to measure gains in the share of residents who reported having a steady source of health care in 2008, its second year of near-universal coverage," cautiously adding that the survey "also raised red flags regarding the ability of residents to actually use that care, with growing numbers saying they could not afford needed treatments and many reporting shortages of primary care physicians."
And adding fuel to the fire is the proposal that is being worked out where hospitals and physicians would receive one lump sum for taking care of a patient for the entire year raising the specter of a futher move toward socialized medicine.
According to The Boston Globe, the newly proposed measures are a direct result of the state's universal health care program, where increased access has raised costs to the point where payments are now going to go along this global route.
What makes the whole thing interesting is the fact that "The new payment system the commission expects to recommend has been tried before; it was known as "capitation" when it initially became popular under managed care in the 1980s and early 1990s. The system broke down when many small physician practices lost millions of dollars on very sick patients with high healthcare costs, and amid widespread concern that the system encouraged doctors to deny patients necessary care so they could stay within their budgets."
Meanwhile, accross the country, small businesses are deciding to cut out health care benefits in order to avoid laying off workers. According to The Wall Street Journal: "As the Obama administration wrestles with broader questions of health-care overhaul, tough economic times are forcing more businesses to grapple with stressful questions about discontinuing coverage. Health-insurance premiums for single workers rose 74% for small businesses from 2001 to 2008, the latest year data are available, according to nonprofit research group Kaiser Family Foundation." And there are signs that this is becoming an entrenched trend as "About 10% of small businesses are considering eliminating coverage over the next year, up from 3% in 2005, according to a recent survey by National Small Business Association."
And perhaps the most startling set of statistics are these: "That follows earlier declines in coverage, with just 38% of small businesses providing health insurance last year compared to 61% in 1993, according to the trade group. In 2007, 41% offered coverage. A Hewitt Associates survey found that 19% of all companies plan to stop providing health-care benefits in the next three to five years," according to The Journal.
As we've noted before, the government is heading in a very dangerous direction. As it has continued to cut Medicare reimbursement, which sets the scale for private insurers, more physicians are opting out of Medicare, at least balking out of adding new patients. And in many cases, physicians have gone to cash only practices, limiting access, either by whom they accept to their practice or by limiting their practice hours.
The result is that there are effectively fewer physicians available to treat an increasing number of older, sicker patients who require more intensive monitoring and treatment adjustments. According to The New York Times: "increased demand for care from the newly insured was confronting an insufficient supply of willing physicians. One in five adults said they had been told in the last 12 months that a doctor or clinic was not accepting new patients or would not see patients with their type of insurance. The rejection rates for low-income adults and those with public insurance were double the rates for higher-income residents and those with private coverage."
Conclusion
The health care crisis is about to reach a crescendo. The government wants universal access, but is not willing to pay for it, in a sense leading to a system where care will be rationed, and will be increasingly unavailable to those with no insurance or bare bones coverage, either private or public.
There are unrealistic expectations at all ends of the spectrum as well, including physicians, insurers, patients, and the government. The fact is that physicians in many specialties have reached the point where their costs of doing business are not being covered by current reimbursement levels, even though hospitals have been receiving steady pay increases for years due to their strong lobbying capabilities.
This sets up a whole new and complex situation, where not only are physician/patient/access issues going to rise in intensity, but where physicians will decrease their dependence on traditional hospitals. This move has been evident over the years where surgeons have moved to ambulatory surgery centers and physician owned hospitals are on the rise.
What should be of concern to all, though, is what will happen to those who need critical access to care at nights, and on weekends, because if the current trends continue, medicine will be a 9 to 5, Monday to Friday endeavour, if it's available at all, unless you have very deep pockets.
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