Monday, August 17, 2009

Health care worker on HR 3200

This is a viral e-mail, if that makes you toss it, so be it. I won't even try to track it down, because the numbers make some sense, and I'm a bit math challenged.
    From a health care worker

    Rationing HealthcareShare

    Today at 1:23 pm I was able to be a part of a large roundtable on healthcare reform last week. I refuse to be one of those people who criticizes but never gets involved. It's like the people who complain about politics but never vote. The hypocrisy, to me, is over-whelming.

    After reviewing (endlessly) HR-3200 and reading countless people's interpretations of it, I am back where I started: This is a common sense issue. We can't make a trillion and a half dollars appear by wishing it into existence. We can't create Medical Clinics that can survive without income. We can't make doctors work 24 hours a day. None of the 'math' in any of this proposal makes sense.

    There are some facts in health care that people 'outside' of health care don't understand. One of these issues is a 'payor mix.' Using arbitrary numbers to make it understandable, it goes something like this:

    It costs 25 cents on every billable dollar to actually see a patient (a bill for a hundred dollars actually consumes 25 dollars in resources). Private Insurance reimburses 40 cents on every dollar (leaving 15 cents for 'profit.' [40 cents - 25 cents actual cost]) Public insurance reimburses 10 cents (creating a deficit of 15 cents per patient). The healthcare facility takes the 15 cent loss away from the 15 cent profit made on the privately insured patient, so that the facility doesn't lose money. So, if a Physician is able to see 20 patients a day, they have to be careful that no more than 10 of them are publicly insured. That number is realistically lowered to 5 because there must be some money for future expansion, charity care, research, and (God-forbid) some profit for the people who make it work. Because of this FACT in healthcare, every provider must watch their 'payor mix.' If there are more publicly insured patients than privately insured patients, then money runs out really quickly. So what does this mean under the 'new' healthcare plan? There is only one logical conclusion: rationing of healthcare. Not mandated by law, but mandated by necessity. Since the number of 'public' slots is rationed to 25% already...what happens when the number of people needing those slots triples? Well, to be frank, nothing. The facility can only see 5 patients (25% of 20), or they don't remain financially soluable. So what will happen is, wait times will triple. Right now, in my practice, the wait time to see a Physician (even if you are privately insured) is about 6-8 weeks. Publicly insured can be two to three times that, depending on specialty. Using 2 months as a really conservative estimate, means that the wait time goes from 2 months to 6 months.

    And so, current (and future) problem number 2: Since the patient can't get into the clinic to see their doctor, they go to the emergency room for a non-emergent issue. Emergency Rooms are substantially more expensive to operate. Here, the cost may be 50 cents on the billable dollar instead of 25. And, it is a fact that most of the people who go to the emergency room at the hospital that I work for are publicly insured patients (not UN-insured, as the government would like us to believe). They go there because their healthcare is already rationed. Privately insured patients have a tendency to avoid the ER for non-emergent issues because they, most often, have a co-pay percent. They won't pay 20% of the ridiculously high priced ER if they can wait and pay it on a lower-priced clinic visit. The publicly insured do not care because it costs them NOTHING either way. And so, more and more go to the ER. Since the public insurance reimbursement does not cover the costs of being seen, that deficit is passed on, again, to the privately insured, causing the facility to 'raise' their payor mix to offset the costs.

    This is a factual cycle that already exists in healthcare, and will only get worse as public insurance expands.

    And it will expand far beyond the currently uninsured. Smaller businesses who currently offer health insurance (averaging between 12 and 15 percent of their payroll expenses) would possibly see the 8% fine (for dropping their employee's coverage) as the only way to stay afloat. There WILL be a mass exodus from private insurance companies. People who like their coverage WILL lose it. Healthcare will become even more rationed. But look at the bright side. It will only cost us 1.5 trillion dollars, according to the Federal Government's projections. . .by the way, the federal government's projected cost for the 25-year Medicare start up was 10.6 actually cost 107 billion.

    To try to put the amount of money that we are talking about into perspective, let me put this forward:

    Counting seconds backward:
    1 million seconds ago was about 11 days ago
    1 billion seconds ago was in 1979
    1.5 trillion seconds ago was approximately 46,000 BC.

    We can't afford any part of this math, even if the $1.5 trillion estimate weren't 1000% off.

    Call your congressman. Really.
Now, I don't have a name to track down for that e-mail, although the reimbursement plan and ER problems sound just like what I've heard about from people who work in medical care. However, this "pediatrician" was apparently a plant, and not a doctor, just a woman pretending to be, at a Texas Townhall. Whether the Obama folks planted her we don't know, but I've never heard a doctor (expect Toes' brother) who supported this.

See her story at Patterico's Pontifications. The Houston Chronicle ran with her story, and didn't check it out. Is anyone who she says she is any more?

1 comment:

Anonymous said...

Nice Post