As the calendar ticks over into 2004, a plethora of interesing, trivial, important, annoying, and otherwise simply new things happen. For one thing, in the middle of cold and flu season just like every year, many Americans change private health plans. This is rarely a completely voluntary choice: either a decision was made by a pointy-haired boss, or the family made a decision balancing cost and benefits to change coverage back in an open enrollment period some months ago.
Families and pointy-haired bosses are not the only ones making hard decisions about health care. Doctors and clinics are making tough choices too. They too have to balance money and healthcare. Among other things, they must decide which health plans and insurance companies pay enough that they can afford to provide treatment.
Many doctors are still in the business to serve others, but even they admit that they can’t afford to provide care below cost forever. A non-trivial number of doctors, like Susan Hershberg Adelman, MD, have determined that it is simply no longer possible to provide medical treatment the poor without joining them in poverty. Her figures citing that over a third of area hospitals have closed in the last 25 years is particularly damning inasmuch as Michigan prohibits for-profit hospitals: no money is being siphoned off to a corporate profit statement and an over-hefty CEO salary.
Reasons she states for closing her own practice include the fact that Medicaid in Michigan only pays 38% of the billed amount. Nor is this an unusual reimbursement figure. Try paying 38% of your bills and see what happens. She also cites high (and rising) malpractice insurance rates and the dreaded “unfunded government mandates.” You hear a lot about those unfunded mandates lately, not just in medicine, but in the costs of implementing DHS Code Orange and No Child Left Behind too. Although she does not mention stringent and sometimes contradictory regulations, that surely played a role too. She specifically does not see a single payer system as an answer because, “If we change to a single payer system, Washington no doubt will franchise it out to the same private insurers that state Medicaid programs contract with today.”
Ah, but some of you are asking why this matters. Record poverty levels, particularly among children, aren’t enough reason for you? How about the fact that long term unemployment is relegating even educated professionals into the ranks of the poor, the uninsured, and the underinsured? How sure are you that your family will not need Medicaid and a doctor like Dr. Adelman in the next 5 years?
American corporations might be able to get computers programmed and research done in India. However, we cannot outsource medical care to foreign nations. The time has come to seriously discuss how to balance “stemming the rise in health care expenditures” with “paying enough for medical care that it will still be available next year.”