KERRYCARE AND TENNCARE

Post lifted from Medpundit

"We don't have to imagine what would happen under Kerry's Medicaid expansion plan. All we have to do is look south, to Tennessee to see the Kerry plan in live action. Since 1994, Tennessee has provided state-funded healthcare with the same eligibility requirements as the Kerry plan. Nine years later the state's governor was calling it the dragon that eats everything, and financial management consultants were warning that by 2008 the program would consume $9 out of every $10 in new revenue taken in by the state. That's a lot of money, money that won't be available for other essential state-provided services.

And yet, despite spending all of that money, Tenncare patients still end up getting the shaft. In the grand American tradition, the program shunned rationing, covering everything from lava lamps to MRI's. The programs generosity, however, did not include doctors and hospitals, whose reimbursement rates are so low that seeing Tenncare patients is a losing proposition. As a result, access to care is a very real problem for Tenncare patients, some of whom have to drive 40 miles just to see a doctor. (And keep in mind, those are mountain miles.)

And what about the children? Only 19% of pediatricians in Tennessee accept Tenncare, the lowest participation rate of any state in the union. As a result, over one-third of children enrolled in Tenncare have trouble finding a doctor. That's a very real problem. And one that's much more serious and damaging to a child's health than lack of insurance.

But under Kerry's Tenncare National, access to care would be even worse. The median family income in the U.S. is $53,991. Three hundred percent of the poverty level for the average family of four is $56,500. Under Kerry, over half of America's families would qualify for the expanded Medicaid coverage. Which would mean that doctors would see their reimbursement drop drastically - to the point that they would have trouble staying in business. You can't squeeze blood from a rock, and the fact of the matter is that the safety margin of the average physician's practice is already razor thin, thanks to the medical liability crisis. And there's no reason to think that a Kerry/Edwards administration is going to enact any meaningful medical liability reform, not with donors like these. With most of the country struggling with rising malpractice insurance premiums, there's just no room for physicians and hospitals to provide mandated charity care for the middle class. The heart may be willing, but the purse won't allow it.

The pincer movement of Kerry's healthcare plan and trial lawyer friends would squeeze doctors right out of the picture. Those physicians who can would retire early, as many already are. Others would probably leave medicine all together. Hospitals that can't make up the difference by soaking the rich would close, as many small community hospitals did under the onslaught of managed care in the 1990's. But in this case, it wouldn't just be rural and inner city hospitals, it would also be suburban and small city hospitals. Only the large tertiary care centers, like Mass General and The Cleveland Clinic, who attract the wealthy the world over would stand a chance. And the future would be even bleaker. Who wants to invest the time and money to go to medical school if it's financially impossible to pay back student loans? The healthcare industry is leading employers in the U.S. Fewer hospitals and doctors not only means less access to care - it means higher unemployment rates. A vote for Kerry is anything but a vote for nurses. And it certainly isn't a vote for children. More people may have healthcare insurance under Kerry's plan, but they'll have a much harder time finding somewhere to use it.

In the last debate Kerry called our current healthcare insurance system high-priced but low-benefit. The implication was that his plan would be low-priced and high-benefit. But everything has a price, and Kerry's is higher than we can afford.





IF IT'S FREE IT GETS USED BY PEOPLE WHO DON'T REALLY NEED IT

A new study on emergency rooms disputes the common wisdom that the poor and uninsured are filling them up. In fact, more than 80 percent of patients seen in emergency rooms have health insurance and a usual source of health care such as a primary care physician, doctors reported on Tuesday. "Contrary to popular perception, individuals who do not have a usual source of care are actually less likely to have visited an emergency department than those who have such care," said Dr. Ellen Weber, an professor in the division of emergency medicine at the University of California San Francisco, who led the study.

For the study, Weber and colleagues looked at interviews of nearly 50,000 adults visiting emergency departments in 2000 and 2001. People without health insurance were no more likely to have had an emergency visit than those with private health insurance, they told a meeting of the American College of Emergency Physicians. People without a regular doctor or clinic were 25 percent less likely to have had an emergency visit than those with a private doctor, the researchers found. Their study, also published in the Annals of Emergency medicine, found that 83 percent of emergency department visits were made by people who had a doctor, clinic or were members of a health maintenance organization. Eighty-five percent had medical insurance and 79 percent had incomes above the poverty level. "The mistaken belief that emergency departments are overcrowded by a small, disenfranchised portion of the U.S. population can lead to misguided policy decisions and a perception by hospital administrators that emergency patients are not as valuable to the institution as patients having elective surgery," Weber said in a statement. "But our findings indicate that emergency departments serve as a safety net, not just for the poor and uninsured, but for mainstream Americans, and in particular those with serious and chronic illness."

A spokesman for the American Hospital Association said he was studying the report but added, "That is not surprising because a majority of people have insurance." An estimated 45 million Americans lack health insurance, but that leaves 85 percent of the population with coverage, either public or private.

Hospitals have long complained that their emergency rooms are overcrowded. Between 1992 and 2002, emergency department use climbed 23 percent, from 89.8 million visits to 110 million visits. The 1986 Emergency Medical Treatment and Labor Act requires any hospital taking part in Medicare -- the state-federal health care insurance program for the elderly and disabled -- to provide "appropriate medical screening" to anyone showing up at an emergency room and asking for it. Hospitals say the rules have burdened their emergency departments with poor and uninsured patients seeking care for everyday conditions. Many have closed emergency facilities in recent years. "Many insurance programs, and particularly public and private HMOs, require beneficiaries to have a primary care physician, which may be expected to improve overall health and health care," Weber said. "But the continued rise in emergency visits implies that such programs have not had a substantial impact on overall emergency department use."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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