Having stomach cramps and are afraid it's your appendix? It's 3am on a Saturday morning and your regular doctor isn't going to be available until next week? Well, head on down to the emergency room... but be prepared to wait. Because while the number of people in the United States has gone from 270,000,000 to 300,000,000 over the past ten years, the number of emergency rooms in America has declined from 4800 to 4500 over that same period of time -- and the number of hospital beds has declined also, from 1,465,828 in 1975, to 1,213,327 in 1990, to 946,997 in 2005. So people back up in the fewer emergency rooms waiting for an open bed in one of the fewer beds available in the medical system.
As Anne Zieger points out, where healthcare is concerned, supply and demand apparently just don't work the way they do in other industries. If demand is going up because a shortage of primary care doctors is leading to even insured people going to emergency rooms for primary care, you would expect there to be an explosion in the number of emergency rooms, not a decline. Supply should increase to match the demand, right? Right?
Except that it doesn't work like that in real life as vs. Republican masturbatory delusions. The reason it doesn't work like that is because of two things: a) health care eats up 15% of the U.S. GDP and sick people don't make 15% of U.S. GDP, meaning that sick people are not capable of paying the full cost of their care, meaning that hospitals can't get emergency room costs reimbursed by the people using their emergency rooms because you just can't squeeze 15% of the U.S. GDP out of people who don't make 15% of the U.S. GDP, and b) insurance companies are refusing to pay for the care that they contracted to pay for, and government isn't making them pay. So emergency rooms, which should be a profit center for hospitals, are instead a massive drain on their financial resources. So no more emergency rooms get built. Not because of lack of demand. Not because of lack of money -- health insurance compannies are making record profits. But because health insurers are refusing to live up to their contractual obligations, and the U.S. government is letting them do so.
Add in the 18% of emergency room visits by the uninsured, and you have a health care crisis. And it's a health care crisis that's 100% predictable. Health insurers have a financial motivation to not pay out claims, so unless there's government intervention to force them to pay out claims, they don't pay. At one time they wouldn't have dared, because from 1968 to 1980 or so they were under warning that if they refused to live up to their obligations, the Medicare system created by LBJ for old farts would be extended to everybody (i.e., Medicare For All) and put them out of business. But nowdays they seem to believe they can simply refuse to live up to their contractual obligations and get away with it. Hmm, I wonder why that is? (Hint: Follow the money... straight into Congress's pockets).
Regarding the current Presidential race: Neither candidate has a plan that will do anything about the continuing collapse of the U.S. health care system, a system that was the best in the world in 1975 but now can only barely provide minimal care for most people under the best of conditions (i.e., no plagues or epidemics) and which would totally collapse if stressed by any major disease outbreak. John McCain continues to utter nonsense about the "magic of the marketplace" despite the fact that the marketplace has utterly failed to provide sufficient emergency rooms and hospital beds to meet the nation's needs, and Barack Obama's plan privatizes the profits of health insurers while socializing the costs (by having government take on the expenses of being reinsurer for people who use more than X$ of services due to need for expensive surgeries or cancer treatments or etc.) while doing nothing to force insurers to live up to their contractual obligations. Both candidates get an "F" from this health care penguin for their health care plans. But McCain gets an "F-", and I'll talk about that one later...
-- Badtux the Health Care Penguin
considering the people making the decisions have no worries about health care.....
ReplyDeleteSadly, our healthcare system is very, very broken. Many people go without coverage (either due to financial necessity or because they are cheap- I tolerate one of those groups better than the other!). Insurers fail to pay up their obligations, and I know our billers battle as much or more with government-based payers as with private payers; out of state Medicaid is a huge problem for us.
ReplyDeleteYour analysis of the role of private insurers in any overhaul is right on. Until they are out of the mix entirely, no real change can happen.
And to make a somewhat inflammatory comment, I have issues with suit-wearing MBAs making gazillion dollars a year who try to tell me what is and isn't appropriate treatment for a patient. It's one of the most frustrating things on earth.
Yikes. I'll just stay in Korea.
ReplyDeleteI personally am of the opinion that for-profit health insurance companies should be banned, and for that matter, that for-profit primary care hospitals be banned. In 1975, when my mother entered nursing full-time, there was no such thing as a for-profit health insurance company. All health insurers were not-for-profit mutual companies, owned by their policy holders and returning all profit to their policy holders either as cash or reduced rates. In 1975, when we had 1,465,828 hospital beds in this country, the only private hospitals were "specialty" hospitals providing things like cosmetic surgery and such, the notion of a private primary care hospital would have made people gasp in horror. It was understood, then, that health care simply was too important to leave subject to the whims of the profit motive.
ReplyDeleteThe problem we have where 1/3rd of our hospitals have been closed and their emergency rooms shuttered are directly related to states allowing private for-profit companies to take over community-owned not-for-profit hospitals and state regulators allowing for-profit health insurers to operate in their states. For-profit companies have an incentive to shutter hospital beds because the fewer beds there are in a community, the more they can charge for them. For-profit insurance companies have an incentive to not pay out on claims, because they don't serve their policy holders anymore, they serve themselves and keep the profits rather than returning them to their policy holders. And we get the expected result. And I do not believe it can be fixed. Or should be fixed.
What we need to do, at a minimum, is get back to 1975 where we take the profit motive out of healthcare by prohibiting for-profit companies from selling insurance or running primary care hospitals. Health care is life or death, not something that should be subject to the whims of a profit-and-loss spreadsheet. The fact that the current system kills people for profit is just sick, and should be as illegal as hiring an assassin to kill people for profit. 'Nuff said.
- Badtux the Health Care Penguin