The Future of Health Care?

[fuegofrio17]

Massachusetts recently passed an innovative bill that initiates mandatory health care for all citizens. The poorest citizens would be given health care credits, while middle income citizens would be offered subsidized health care. Citizens earning over a certain income would be taxed $1000 if they failed to carry a health plan. Additionally, employers would be required to pay $295 per employee toward health insurance.

This bill creates an interesting debate regarding universal health care coverage and socialized government (forcing businesses and individuals to both pay for insurance). From first view, this system appears to benefit emergency physicians by guaranteeing a payor for all emergency visits. Any thoughts?

http://www.msnbc.msn.com/id/12156882/

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[Telemachus]

The libertarian in me does not like the government fining people who have weighed their options and thoughtfully chosen not to have health insurance.

The pragmatic part of me recognizes that these individuals are rare and that most people with a decent income and no health insurance are just gambling, with potentially disasterous consequences.

I'm never really a fan of the "Hey, let's just have the government pay for it" attitude that underlies the rush to get this bill passed. The article implies that a motivating factor for the legislature was making sure they didn't lose out on hundreds of millions of dollars that the federal government had previously pledged.

I like the sliding scale aspect of the low to middle income part of the plan. I guess that makes me some sort of socialist/communist. Oh well....

What will this mean for reimbursements in MA?

 

[EctopicFetus]

Hey why ever use our brains. We can just have the government tell us what to do in every aspect of our lives. Havent we already figured out that socialism and communism just dont work. In a utopian sense its great but practically people are people and this just doesnt work.

Overall I imagine reimbursement would go up, the bigger question is why would anyone want to start a business there. *Rant beginning* We already know that one of the reasons US automakers are struggling is because the unions (another socialist concept) like UAW require Ford and Gm and others to pay health insurance this tacks on about 1500 - 2000K on EVERY car they produce. Is there any wonder why Hyundai who has opened up non unionized US plants is in the middle of kicking their butts? Also look at Toyota and the Japanese auto makers..

*Rant over*

 

[deleted87716]

What will this mean for reimbursements in MA?

Ah...the $1M question!

 

[futuromd]

I think your right about its potential economic effect on EM due to a "guaranteed" payor. However, I suspect many of these previously uninsured visits will now go to their primary care physicians.

More importantly though, it has important implications for the millions of uninsured people out there - (Of course, we'll have to see if it works on a smaller scale first). I like the "middle of the road" approach - referring to the shared responsibility of health insurance costs between companies and individuals, including the sliding scale approach.

Although this will increase company expenses, you could also argue the point that healthier/happier employees = more productivity = more profit. This may be somewhat idealistic but there is some truth.

Anyway, I'm curious to see how it turns out and what implications this may have for the future of US health care.

 

[bartleby]

The effect of a lack of insurance on the propensity to visit the ED is greatly overblown. If I'm a physician and I have trouble getting through to Mrs. Smith's PMD, imagine how tough it is for this little old lady? It winds up being easier for people to come to the ED for many common problems, insured or not. (see abstract below)

I think your right about its potential economic effect on EM due to a "guaranteed" payor. However, I suspect many of these previously uninsured visits will now go to their primary care physicians.

As far as increasing company expenses goes, the federal government already sacrices something along the lines of $160 billion in lost tax revenues by giving companies a deduction for money spent on health insurance costs, so this doesn't seem like as much of a blow as it looks.

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Authors:
Weber EJ; Showstack JA; Hunt KA; Colby DC; Callaham ML (Annals of EM, 1/05)

Abstract:
STUDY OBJECTIVE: We determined whether having a usual source of care or health insurance is associated with the likelihood of an emergency department (ED) visit. METHODS: This was a multivariate analysis of the 2000 to 2001 nationally representative Community Tracking Study Household Survey to assess the independent association of usual source of care, health insurance, income, and health status with the likelihood of making 1 or more ED visits in the previous year. RESULTS: Based on a sample of 49,603 adults, an estimated 45.3 million adults reported 79.6 million ED visits in the previous year; 83.1% of these visitors identified a usual source of care other than an ED. Persons with poor physical health status made 48.4% of visits. Adults without a usual source of care were less likely to have had an ED visit than those whose usual source of care was a private physician (odds ratio [OR] 0.75). Uninsured individuals were no more likely to have an ED visit than insured individuals. Poor physical health (OR 2.41), poor mental health (OR 1.51), 5 or more outpatient visits during the year (OR 4.05), and changes in insurance coverage (OR 1.14) or usual source of care (OR 1.32) during the year were associated with an ED visit. Enrollment in a health maintenance organization and satisfaction with one's physician were not independently associated with ED use. CONCLUSION: ED users are similar to nonusers with regard to health insurance and usual source of care but are more likely to be in poor health and have experienced disruptions in regular care. The success of efforts to decrease ED use may depend on improving delivery of outpatient care.

 

[docB]

I think your right about its potential economic effect on EM due to a "guaranteed" payor. However, I suspect many of these previously uninsured visits will now go to their primary care physicians.

I would not expect to see people going to PMDs just because they now have "insurance." Most will still abuse the ER because it's easier and because they always have. You could actually make the converse argument that now the low income working people who avoided the ED because they would get hit with the costs will now start to abuse the ER.

 

[docB]

What will this mean for reimbursements in MA?

You guys are right that this will make the payor mix improve and that's good but here's the downside. The increase in your payor mix will be in the medicaid segment which gives you the worst CPV (cash per visit) of any payor. You can be sure that the bean counters will be watching the revenue streams and if the bottom line for EPs (or hospitals or anyone else) rises they will reduce reimbursement. The politicians and the public will not allow docs or anyone else (except politicians and bureaucrats) to benefit from an entitlement.

Nothing has been said about people who present that are not residents. Presumably they will not be covered. That's a significant issue in the northeast where there are lots of little states close together and in places that are tourist destinations (see my angle on this ).

 

[GeneralVeers]

The Canadian medical system used to be a privately financed system until the 1960's. The government sold doctors on a Medicare single-payer system. They told doctors that they would receive higher overall reimbursement, as they wouldn't have any non-paying visits or collections. Initially this turned out to be true, but as time went buy reimbursement did not keep up inflation. With the government dictating exactly how much they'd pay, and no option for private reimbursement, doctors became completely dependent on government. As a result most Canadian doctors make 1/3 to 1/2 the salary of the U.S. counterparts.

It's for this reason I'm against any more legislation which would put us closer to a single payer system.

 

[MacGyver]

The Canadian medical system used to be a privately financed system until the 1960's. The government sold doctors on a Medicare single-payer system. They told doctors that they would receive higher overall reimbursement, as they wouldn't have any non-paying visits or collections. Initially this turned out to be true, but as time went buy reimbursement did not keep up inflation. With the government dictating exactly how much they'd pay, and no option for private reimbursement, doctors became completely dependent on government. As a result most Canadian doctors make 1/3 to 1/2 the salary of the U.S. counterparts.

It's for this reason I'm against any more legislation which would put us closer to a single payer system.

I agree with you about Canada but the truth is that eventually the USA will be a de facto socialized med status becasue of the influence of medicare. By 2020, Medicare will control 75% of all healthcare dollars spent in the USA. That gives them sufficient monopoly power to dictate doctor incomes at all levels.

 

[EctopicFetus]

dude u dug this this up from the grave..

 

[turtle md]

socialism ... just dont work.

I disagree. Sweden, a socialist country, seems to be doing just fine. Doctor's don't get paid squat, but that is different from a system not working.

 

[hoboken]

I

 

[desoto]

wow

 

[Vox Animo]

I disagree. Sweden, a socialist country, seems to be doing just fine. Doctor's don't get paid squat, but that is different from a system not working.

Also in sweden you cannot work privately as a doctor unless you can offer all the services that a hospital does. So most just end up working for a hospital.

 

[Miami_med]

I think some research into Sweden's healthcare system would show a lack of perfection and the same problems that have impacted all socialized medical systems. However, a national healthcare plan does appear more effective in a small country with less space, fewer people, and a much more homogenous culture. In other words, the decisions of the government will reflect the views of the people to a greater degree, and the decisions that they impose will be in concordance with the wishes of a larger proportion of the population. Were the system not socialized, more people would operate in the same manner. This cannot be said for a country as large and diverse as the U.S.