Too much, too little
Country splurges on unneeded care while others lack access
Notes on the news:
Critics have blasted the health reform law’s provisions to determine which treatments work and which don’t. They complain that bureaucrats armed with such information will coerce providers and patients into accepting chintzy medical care.
They needn’t worry. The forces aligned in healthcare to thwart rapid adoption of more efficient care are too strong. The latest example comes via a study in the May 11 Jour
nal of the American Medical Association. This study looked at 2007 research that made headlines when published. That research showed that intensive drug treatment in nonemergency patients with chest pain worked just as well as angioplasty in preventing heart attacks. It improved survival and relieved discomfort in the long run.
Last week’s article reported that two years after the initial study, there was only a tiny increase in patients given drug treatment first. Not only is the drug regimen more beneficial to the patient, it also saves money. Experts estimate that more than $2 billion could be saved if drug treatment were tried before resorting to angioplasties.
The author of the 2007 study was quoted in an Associated Press story as saying physicians and patients resist drug treatment for a variety of reasons. Patients may see drug therapy as too time-consuming and just want a quick fix, for example. Doctors may fear lawsuits if they don’t pull out the high-tech guns and the patient later suffers a heart attack. He might have added the lure of higher reimbursement. The American healthcare culture promotes escalating use of resources—at least for those who can afford it—even when the treatments may be inefficient and harmful. It’s hard to see anything on the horizon— and certainly not the Patient Protection and Affordable Care Act—that will
quickly change the more-(and more expensive)-is-always-better culture.
The high price tag for care in this country naturally hurts those least able to pay for it. An HHS report released last week showed that uninsured patients can afford to pay about 5% of the amount hospitals bill for care.
The analysis reviewed household assets and income among the uninsured in 2006-07 as well as hospital bills and the cost of hospital care in 2008. Assets were defined as bank accounts and other possessions that could be easily converted to cash. Researchers found that the median uninsured households with income below 200% of the federal poverty level essentially had no assets to pay hospital bills. Median uninsured households with income above 200% of the poverty threshold but below 400% of the line had $300. This study used old figures. Consider the joblessness created by the Great Recession and the previously mentioned high prices, and you can see why it’s tough to be poor and sick in this country.
States are taking different—sometimes wildly different— approaches to the problem of access to care. Earlier in this issue, we noted how Vermont is seeking to establish a universal, government-run healthcare system. Florida, on the other hand, has passed a bill that will place Medicaid recipients in private managed-care plans. Republican lawmakers and GOP Gov. Rick Scott (formerly chief of Columbia/HCA) backed the measure. This funneling of public money into private plans is unlikely to control costs (think Medicare Advantage) and probably will result in fewer services to Medicaid recipients since the plans will get a cut of the savings. Other beneficiaries could include urgent-care clinics catering to Medicaid patients, such as the one Scott founded.
But you can be sure that while some gain, those with the fewest resources will suffer.