Covering low-income people through public programs such as Medicaid and the State Children’s Health Insurance Program (SCHIP), rather than through private health insurance, results in lower per person medical spending and considerably lower out-of-pocket expenses for consumers. That’s the conclusion of a new study published today on the Health Affairs Web site, which looks at different ways of providing health insurance to Americans with family incomes below 200 percent of the federal poverty level. (For a family of four, 200 percent of the 2008 FPL is $42,400.) http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.4.w318
Has anyone been paying attention to what's been happening to access to care in public health programs here, Europe and Canada? Not on the left where ideology trumps concern for patients:
Many states have used the same approaches to cover the uninsured and to make existing premiums less expensive. Instead of doing so, such proposals have driven many doctors out of government-run programs and have rationed access to new medicines. Private insurers are leaving markets. And patients who are forced to wait months for needed care often wind up not getting the medicines they need.
For example, Nicole Garrett's three teen-age children lost their private coverage, so she lost her private coverage and enrolled them in Michigan's managed-care Medicaid program.
According to a 2007 article in the Wall Street Journal by Vanessa Furhmans, when Nicole's 16-year-old daughter, Jada, needed to see a rheumatologist, the one listed in her managed-care Medicaid plan's network would not see her. Nicole notes, "When we had real insurance, we could call and come in at the drop of a hat."
Mr. Kennedy was rushed into surgery less than two weeks after his diagnosis. Jada's wait just for an appointment was a bit longer: The wait to get into a public clinic was more than three months. By the time she found a Medicaid-approved rheumatologist in a nearby county to take her in months later, Jada's debilitating pain had caused her to miss several weeks of school.
Edith Andrews of Zanesville, Ohio, faced the same problem when her twin girls, Sara and Samantha, were born prematurely nearly four years ago. Each weighed less than 3 pounds and needed a ventilator to breathe.
According to an article in the Cinncinnati Enquirer: "To get care she had to take her infants to a Zanesville clinic or an emergency room, where they saw a different doctor every time, if they saw a doctor at all."
When Sara's lung collapsed, Edith couldn't find a Medicaid pediatrician to care for her. "Sarah's complications got worse and worse, and there was never a doctor around when I needed to talk to somebody." She finally found a doctor to take her daughters on as patients after a year of searching.
Mr. Obama (and those providing support his approach in Health Affairs) would also create a new health board to create lists of "cost effective" new drugs and medical devices, and set prices for their payment. Similar review boards in Canada and Europe delay access to new medicines by months or years and are biased by cost-containment considerations.
In the Medicaid and SCHIP programs, such "preferred lists" have made it harder for people like Melissa Brown of Cincinnati to get the right drugs for her 6-year-old son, Max, who suffers from bipolar disorder and other psychiatric illnesses. Under private insurance, her doctor was able to choose a drug that controlled unpredictable and violent behavior. The drug treatment she got for Max "changed his life."
But now Melissa and Max are in Medicaid and bureaucrats, not doctors, will decide which drugs he will get, based on the cost-effectiveness standards Mr. Obama wants to impose on us all. Max will have to change his prescriptions and get authorizations for new medications...."
www.washtimes.com/news/2008/jun/17/obamacare/
And of course the public health system has worked so well north of the border for our new found friend Shona Holmes:
Shona began losing her vision in 2005 and got an MRI in Ontario that showed a brain tumour. That was only after she had to wait three montns for an appointment for a neurologist and another for the MRI which was preceded with a misdiagnosis of the tumor as a stroke in the ER. Forced onto a wait list (up to six months to see an endocrinologist) as her eyesight deteriorated, she went to the Mayo Clinic in Arizona where she eventually got surgery to remove the tumor. The Canadian health system refused to pay for the care at Mayo which, if she had not received, would have meant death. Now she and her husband have exhausted their savings to pay for the care they should have obtained without a fight and only paid 30 percent of their income in taxes for over the last 30 years.
