What Medicare Needs?

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Most of you know that I believe in universal health insurance. Because in the long run it will save us (as a nation, and individually) money.  Notice, I did not say universal “free” health insurance, even though I recognize that about 10% of Americans can’t afford it, another 10% will need help paying for all of it, and about 15% of Americans think they don’t need it.  (Of course, about 15% – or more- of Americans don’t think they need car insurance, but that doesn’t mean we don’t demand they carry it.)

US residents with employer-based private healt...
US residents with employer-based private health insurance, with self insurance, with Medicare or Medicaid or military health care and uninsured in Million; U.S. Census bureau: Income, Poverty, and Health Insurance Coverage in the United States: 2007 (Photo credit: Wikipedia)

One of the biggest costs we have in health care is indiscriminate use of emergency care.  We think that many people, who don’t have insurance, can’t see a primary care doctor and know they can drop into a hospital, wait a day or two (ok, it certainly feels like the wait is that long), and get the treatment they need.

But, maybe the problem is that we haven’t really thought through how we set the system to handle these folks.  Which is going to be a primary issue with Obamacare (PPACA)- because we are going to extend Medicaid insurance to the working poor, as well as the poor.  And, we lack the primary care doctors we need for a large increase in covered care needs.

Some folks live in cities or counties that have a reasonably effective public health clinic system.  Where someone is able to make an appointment and see a primary care practitioner (nurse practitioner, physicians assistant, physician) and receive treatment.

But, some places lack these systems.  Or, they have poorly staffed primary care clinics, where one can wait for 30 minutes, 50 minutes, 70 minutes on the phone just to make an appointment.  (Don’t tell me they can use the web to do so- that assumes they have internet service in their homes- and many of these self-same cities lack adequate internet services themselves.)  Worse yet, they are often advised that the wait for an appointment is 50 or 60 days hence.  But, the pain exists NOW!  (I would go to the emergency room, too, given these circumstances.)

Or, the system lacks a decent electronic health care record system.  So, that each time, the same questions arise, the same diagnostics are applied, all of which increase the costs of care and negate the quality of care.

Moreover, while Medicaid often pays for taxi service to the clinic, the system demands a 3 day notice to do so.  So, if one needs to go to the practitioner today, the only way to do so is via ambulance- at ridiculous costs to the system.  (Here in the DC region, we have MetroAccess, a shared ride system for those with disabilities- but not really for the poor.)

Then, we need to factor in the 10% of patients who visit the hospital, because there are few practitioners who accept patients insured under the program.  (Some practitioners “cheat” by accepting appointments for “regular” patients within a day or two, while telling those insured by Medicaid that the wait is 50 to 70 days.  You know, like the old standby system of the airlines.)

All of these factors are why a new sort of business is sprouting up.  Some needs are being provided by private enterprise (primarily savvy entrepreneurs); others by the state itself (California comes to mind).  These “navigators” or “advisors” help the patients manipulate and maneuver within the constraints to obtain the care they need- and deserve. This includes food vouchers (if needed), transportation, appointments, and the explanation of the rules that obtain.

Given the employment situation in the States, maybe more of us should be learning how to provide such services…

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2 thoughts on “What Medicare Needs?”

  1. That’s a great initiative, Roy. It looks like a win-win situation, which is what entrepreneurs everywhere seem to be desperately looking for. The only problem I see is the government will to recognize the problem and act accordingly. Being the government, many entrepreneurs may feel restrained to deal with the big guys so, maybe the government should give the first step and provide a ground regulation, inviting private folks to fulfill the needs. That premise would make the project fail in countries like mine. Hopefully, USA knows better.

    1. Gustavo:
      It is pretty clear that those states that ceded control to the Federal government will have funds for these programs. Because the Federal government understands the needs of the various citizens to navigate the system. For those states managing their own programs, it seems that California- and perhaps, New York- have agreed that these services are warranted.

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