A recent U.S. News & World Report article pitched the Harvard view of the Affordable Care Act. Essentially, their take on it was this: The problem with Obamacare is that we haven’t spent enough money. More money thrown at the problems of health care in the U.S. will lead to “better” health care and longer life.
When you live in an ivory tower and don’t have to deal with the day-to-day issues your patients are facing, you have the luxury of this kind of magical thinking. But as a practicing physician, I deal with patients and local governments who have finite budgets. Just as college graduates aren’t educated because they have a degree (they have a degree, or at least they did in the old days, because they’re educated) — giving more money to people who haven’t developed the habits and values to earn it themselves is not likely to change their health for the better.
I saw an example of this in prenatal care when I was a cardiology fellow at an inner city urban hospital. Some pregnant patients simply didn’t avail themselves of free prenatal care. They knew it was available. They knew it was free, but they didn’t show up to their OB clinic until late in the third trimester.
I subsequently saw them in the cardiology clinic due to their poorly controlled hypertension.
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People who are disciplined, prudent and moderately ambitious make more money — and also take better care of their health.
Plus, the money isn’t there. If you really want to address the problem of inequality in America, you have to take 20 percent of the salaries of the people making between $100,000 and $500,000 and give it to the people making under $100,000. That’s where the “inequality” that really affects people’s lives is.
Even in doing that, there just isn’t enough money among the “super-rich” or the one percent to change the lives of the bottom 20 percent. So let’s stop these pronouncements about how to improve U.S. health care as if there were no limits on resources that can be spent.
Let’s be candid.
Having health insurance doesn’t mean having access to health care. Medicaid is a notable example of this. Instead of busting state budgets by expanding Medicaid, let’s fix it. Federal and state spending on Medicaid is skyrocketing. Medicaid is the largest budget item in many state budgets.
With Obamacare’s expansion of the program, it is growing even larger in some states. Yet studies also show that Medicaid is ineffectual at improving health outcomes.
We are spending more for less. This must change.
Part of the cost problem is that Medicaid has a long history of fraud and abuse. At the same time, due to a burdensome reimbursement process and low reimbursement levels (66 percent of Medicare, on average), many physicians refuse to accept Medicaid patients.
I fall into this category.
I retained an interest in heart problems in pregnancy. As a favor to colleagues at a local academic institution, I joined D.C. Medicaid so I could take care of those patients. Those colleagues needed an experienced provider and I have always found this area of cardiology particularly interesting. But my experience turned to frustration. My office manager brought to my attention that Medicaid was not reimbursing me despite assurances that my submitted bills were being correctly processed.
Finally, they admitted they really had no intention of paying me, ever. They had too many other costs and figured that based on my office zip code, I wouldn’t mind.
Having no recourse to their delinquency (more than $800,000 of care over a decade), I simply quit the program. The cost and medicolegal risk were too great. By law, I can now neither see nor bill patients outside the D.C. Medicaid program. Who lost? We all did. I am not able to care for these patients and their costs to society increase because medical intervention occurs later in their disease process.
Medicaid is another case where having federally approved “insurance” is not the same as having real medical care — not to mention improved health outcomes.
The current system is neither solvent nor effective. The states must be given greater flexibility to use federal Medicaid dollars to develop better, more cost-effective ways to improve health outcomes for the needy. Medicaid drug costs are crippling their budgets. I have previously pointed out how the U.S. subsidizes drug costs abroad. Medicaid is particularly weakened financially by this price discrimination.
Let me make a suggestion to the Ivy League academics who like to opine of real world problems from their ivy towers. Herodotus in the 5th century BC reported that whenever the ancient Persians reached a group decision while sober, they later reconsidered it while intoxicated. Why? To prevent “Groupthink.”
As a result of not including outside experts with differing opinions, we got Obamacare. I hope meaningful physician input occurs with the next administration. Human lives and the fiscal future of our country are at stake.
Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, is CEO of Foxhall Cardiology PC.