Do-it-your­self ra­tioning

Has the na­tion reached a ‘new nor­mal’ in how much care we can af­ford?

Modern Healthcare - - OPINIONS EDITORIALS - DAVID MAY As­sis­tant Man­ag­ing Ed­i­tor/fea­tures

At least sev­eral times dur­ing the past cou­ple of weeks, it sure felt as if the na­tion had been trans­ported back in time to the late 1960s. We saw head­lines about manned ex­plo­ration of the moon— in fact, this time the idea floated was lu­nar col­o­niza­tion, with pos­si­ble state­hood! At the same time, we heard re­ports from the front lines of a war zone de­cry­ing the lat­est “car­pet bomb­ing” cam­paign.

Of course these weren’t flash­backs to the Apollo space pro­gram or dis­patches from Viet­nam. All the head­lines came cour­tesy of the lat­est round of de­bates and stump­ing in the cam­paign to se­lect the 2012 Re­pub­li­can nom­i­nee for the pres­i­dency.

Late-night comics had some fun with the space-base pro­posal from for­mer House Speaker Newt Gin­grich, but res­i­dents of Florida could not have found much hu­mor in the non­stop aerial at­tacks of neg­a­tive po­lit­i­cal ad­ver­tis­ing they had to en­dure. Ap­par­ently, it was a fusil­lade for the ages.

Mean­while, some­thing for­mer Mas­sachusetts Gov. Mitt Rom­ney men­tioned dur­ing a de­bate a few weeks back also drew some me­dia in­ter­est—the con­cept of il­le­gal aliens “self­de­port­ing.” (Here, by the way, we’re talk­ing about hu­man be­ings, not some alien life forms that might have their sights set on Gin­grich’s moon colony.) The idea is to make it so dif­fi­cult for il­le­gal im­mi­grants to find em­ploy­ment in the U.S. that they’ll vol­un­tar­ily leave the coun­try. Will this work? That’s a topic for an­other ed­i­to­rial.

We have a dif­fer­ent ques­tion for all the pres­i­den­tial can­di­dates, in­clud­ing the in­cum­bent: What about the al­ready preva­lent prob­lem of “self-ra­tioning” when it comes to vi­tal health­care ser­vices?

Just about ev­ery at­tempt at re­form­ing our health­care sys­tem over the years has drawn fire from crit­ics about what they say will be the ul­ti­mate ob­jec­tive of cost-cut­ters: re­duc­ing spend­ing by lim­it­ing ac­cess to nec­es­sary care. But it’s been the fray­ing safety net and a trou­bled econ­omy that have in­creas­ingly led us down the path to self-im­posed ra­tioning.

The es­sen­tial words in this dis­cus­sion are “nec­es­sary care.” All of us should agree on the need to avoid un­nec­es­sary health­care spend­ing, whether it’s choos­ing a generic drug over the brand name or mak­ing an ap­point­ment with an ur­gent-care clinic rather than rac­ing to the ER. In many cases, we’re talk­ing more about bud­get­ing than ra­tioning.

But far too many Amer­i­cans are be­ing forced to make painful choices when it comes to how much health­care they can af­ford. The Great Re­ces­sion did heavy dam­age, and our re­cov­er­ing, yet weak, econ­omy con­tin­ues to pinch our re­sources, in­di­vid­u­ally and at all lev­els of gov­ern­ment.

Just last week, Mod­ern Health­care re­porter Me­lanie Evans pre­sented new data on this topic in a Jan. 27 post on her “Of In­ter­est” blog. Cit­ing a sur­vey by the Cen­ters for Dis­ease Con­trol and Preven­tion, Evans shares data on how high un­em­ploy­ment has af­fected ac­cess to health­care. “Not only were the un­em­ployed more likely to be unin­sured, but they were also more likely to re­port se­ri­ous psy­cho­log­i­cal dis­tress and fair-to-poor health,” Evans writes. “Un­sur­pris­ingly, the un­em­ployed also re­ported more dif­fi­culty pay­ing for needed med­i­cal care and pre­scrip­tions. Among the un­em­ployed and unin­sured, 41.2% said they put off or did not seek care be­cause of cost.”

In the Jan. 30 is­sue of Mod­ern Health­care, re­porter Jaimy Lee re­ported on the lag­ging come­back in elec­tive surg­eries that also suf­fered dur­ing the eco­nomic slump. While some ob­servers are ex­pect­ing a resur­gence, cit­ing pent-up de­mand for pro­ce­dures such as hip and knee im­plants, oth­ers aren’t so sure. One an­a­lyst says the low num­bers ac­tu­ally could rep­re­sent health­care’s “new nor­mal.”

Given all these trends, ef­forts to en­er­gize our econ­omy might be the best place to shoot for the moon.

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