Stamp of ap­proval

Fed­eral health­care agen­cies might learn a few lessons from the Postal Ser­vice

Modern Healthcare - - Opinions Editorials - DAVID MAY As­sis­tant Man­ag­ing Edi­tor/Fea­tures

The sound bites should still sound fa­mil­iar. It wasn’t that long ago, near the height of last sum­mer’s town-hall furor over what would be­come of our coun­try if Congress had the temer­ity to en­act health­care re­form leg­is­la­tion. We were warned that the im­pend­ing “govern­ment takeover of health­care” would com­bine “the ef­fi­ciency of the post of­fice” and “the com­pas­sion of the In­ter­nal Rev­enue Ser­vice.” Or an­other ver­sion: “If you like the Postal Ser­vice, you’ll love so­cial­ized medicine.”

Well, as it turns out, Amer­i­cans ac­tu­ally do like the U.S. Postal Ser­vice. A lot, judg­ing from the re­sults of a widely re­ported pub­lic opin­ion poll re­leased last month by the Pew Re­search Cen­ter. And we’re also fairly fond of a few other agen­cies of the fed­eral govern­ment, in­clud­ing some health­care-re­lated. On the other hand, we won’t men­tion the poll’s find­ings about Congress.

The re­sults are part of Pew’s poll that set out to gauge the level of anger in the Amer­i­can elec­torate—aptly ti­tled Dis­trust,

Dis­con­tent, Anger and Par­ti­san Ran­cor.

Some 83% of those polled have a “fa­vor­able” opin­ion of the Postal Ser­vice, while the fig­ure is 67% for the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, 58% for the Food and Drug Ad­min­is­tra­tion and 57% for the Vet­er­ans Af­fairs Depart­ment. All of those per­cent­ages, how­ever, are de­creases from a sim­i­lar poll con­ducted in 1997-98. For the FDA, the fig­ure is down by 17 per­cent­age points, while the CDC dropped 12 points. The Postal Ser­vice fell 6 points while the VA saw only a 2-point drop.

Among re­spon­dents’ rea­sons for the flag­ging trust: per­ceived in­ef­fi­ciency and the be­lief that govern­ment is fo­cus­ing on the wrong pri­or­i­ties.

HHS and the CMS weren’t in­cluded in the polling. Given the over­all pop­u­lar­ity of the Medi­care pro­gram among Amer­ica’s se­niors, one would think that the agen­cies re­spon­si­ble for its ad­min­is­tra­tion could garner some fa­vor­able marks. But that cer­tainly wouldn’t be the case if hos­pi­tal ex­ec­u­tives and physi­cians were polled, given re­im­burse­ment un­der fed­eral health pro­grams. And any­body keep­ing track of the most re­cent sto­ries on Medi­care/Med­i­caid fraud would most cer­tainly flunk these feds.

The on­go­ing amount of tax money wasted—tens of bil­lions of dol­lars an­nu­ally by even the most con­ser­va­tive es­ti­mates—is un­con­scionable given the nation’s bud­getary freefall. Any dis­cus­sion of fis­cal ef­fi­ciency would be a joke given the money cas­cad­ing down the drain.

Maybe it’s time for the CMS and other agen­cies to get a few point­ers from the Postal Ser­vice.

Last month’s pas­sage of a di­vi­sive, con­sti­tu­tion­ally ques­tion­able im­mi­gra­tion law in Ari­zona has proved to be a flash­point for the is­sue. Once again, a push for re­form is roil­ing the nation.

An­i­mos­ity to­ward il­le­gal im­mi­grants flared re­peat­edly dur­ing the health­care de­bate, es­pe­cially re­gard­ing their con­sump­tion of health­care re­sources, the con­tention be­ing that they are dis­pro­por­tion­ately suck­ing vast sums of money—in­clud­ing tax dol­lars—out of the sys­tem.

Based on one re­cent study, that doesn’t seem to be the case. The study, pub­lished by Health Af­fairs in Fe­bru­ary, while not able to draw con­clu­sions specif­i­cally on un­doc­u­mented im­mi­grants, uses data on the gen­eral im­mi­grant pop­u­la­tion to make the case these peo­ple not only aren’t dis­pro­por­tion­ately high users of health­care ser­vices, their costs come in lower than those for na­tive pop­u­la­tions.

While the find­ings did show that im­mi­grants were some­what more likely to have health­care en­coun­ters clas­si­fied as un­com­pen­sated care, that most likely re­flects low so­cio-eco­nomic sta­tus and poor ac­cess to care.

This nation cer­tainly needs to have a frank, long-over­due dis­cus­sion on com­pre­hen­sive im­mi­gra­tion pol­icy. What we don’t need is yet an­other round of dis­trust, dis­con­tent, anger and par­ti­san ran­cor.

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