Friday, February 25, 2005

Health Care: Republican Style

Say what you like about Republicans, but they have a health care plan. In fact, they have many plans for this great country of ours, but the health care plan, highlighted in this NY Times article, is particularly troublesome. I have some particular insights in this arena, since part of my job is working with the poor in a healthcare setting.

The details: Recently appointed Director of Health and Human Services and Tommy Thompson replacement Michael O. Leavitt used to be the Governor of Utah. While Governor, Mr. Leavitt completely restructured the way Medicaid is administered, and not for the better. According to the article:
"In Utah, Mr. Leavitt's plan departs from the traditional Medicaid program on two main fronts. First, it spreads out a lower, more basic level of care to more people, and reduces coverage for some traditional beneficiaries by imposing co-payments for services. And second, it relies on the generosity of doctors and hospitals to provide specialty services free of charge."

When it's stated that way, it doesn't sound as sinister as it really is. What's not in the details is that Medicaid would essentially be administered by Emergency Rooms, and that poor people would have to pay for certain types of care. When patients can't pay, hospitals and doctors would have to go pro bono, that is, give services away for free. There are so many ridiculous aspects to this approach, that I don't even know where to start.

First of all let's be perfectly clear, poor people currently utilize the Emergency Room like a primary care doctor. Anyone who has ever worked in a hospital will tell you that. The plan would change very little in how care is delivered to the poor. If anything, it encourages the poor to continue this practice.

The problem is that this is an incredibly expensive way to receive health care. Some estimates put the cost as high as 4 times greater to receive basic care in an Emergency Room setting, than in a doctor's office. Who pays that extra money? Tax payers. You and me. The additional hidden pitfall of receiving Emergency Room care as opposed to going to Urgent Care or your doctor is that when I come in having a heart attack from too much coke, there's a herd of bums there with sore throats. It clogs the system.

The second major flaw of the Utah approach is that it relies on something in short supply in this country, the charity of doctors and hospitals. I work with doctors in a non-profit hospital. My hospital already hemorrhages money providing many services for free or incredibly reduced costs. But, to keep the bottom line in the same zip code, we do what many corporate hospitals do already, shift costs to those who can afford to pay.

The Republican plan endorses both of these practices, as though they would be beneficial to the poor and society in general. Unfortunately, Leavitt's plan doesn't just anally invade the poor, it completely screws the rest of us as well. Not only can I personally guarantee you that you will pay more for health care, but the system will force us to start rationing care.

There is absolutely no doubt that health care resources are expensive and limited. When it comes to providing health care to those who are poor, young, or disabled there is no plan that will provide unlimited care to everyone. But, to accept a system that assumes that poor people can afford to spend the limited resources they have on health care, that doctors and hospitals will become free clinics, and that emergency rooms are efficient delivery models for health care makes as much sense as that fuck a virgin to promote abstinence campaign I've been working on.

The most disgusting and simply illogical part of the entire thing is that the motivation behind it all is to save money. Not only would health care cost more for everyone, since in order to keep their doors open hospitals and clinics would shift costs to those who can pay, but Medicaid would be about as useful as having one of those Monopoly game cards that says you're in good health.

Why would anyone support this? Only if you were 1) A complete and utter moron or 2) You could afford health care, regardless of how much it costs. Unfortunately, the President and his cronies fall into both categories, and that's bad news for the rest of us.

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