SUNBATHING ON THE TRACKS

A recent ACC News Digest blurb referenced the following:

Kaiser Health News (5/16, Galewitz) reports that “Florida wants to be the first state in the nation to charge most of its Medicaid recipients a monthly premium as well as $100 for using the ER for routine care.” However, “even supporters acknowledge that the new fees, passed recently by the state legislature as part of a sweeping Medicaid measure, face long odds getting federal approval.” Although “federal health officials have said they want to give states flexibility in running their Medicaid programs, the new premium could violate the 2010 health law, which bars states from making it more difficult for people to enroll in Medicaid, according to guidance from the US Health and Human Services Department.”

If it hasn’t become apparent by now, all Americans should take note of the pattern: every attempt to reduce overuse and inappropriate use of the health care system is and will be systematically countered by a law, or a lobby. Health care liberals, apparently backed in this case by law, will cry out about the injustice of denying health care to the neediest, the indigent. Even if we grant that the great majority of the recipients are truly needy, and in these tough economic times that percentage has surely grown, the operative term here is “routine” care.

Emergency rooms are already becoming overburdened, and one of the reasons for this is laws that prohibit them from turning anyone away. In other words, everything must be treated as if it’s an emergency. What that means to the insured and the true “self-pay” patient with financial resources are extremely high charges for the former, often dickered down from exorbitant to simply outrageous, and absurdly high charges for the latter. But the “self-pay” patient most of us are accustomed to providing emergency services for is typically unemployed or poorly employed, sometimes homeless, sometimes illegal, and not infrequently impaired by mental illness or alcohol and drug abuse. For this group, “self-pay” usually translates to “no-pay.” Of course, for the paying customer this means inflated charges. And an emergency room is one of the most expensive venues to provide care, even if charges reflected true costs.

So I’m in favor of using less expensive and more appropriate venues to provide nonemergent care, and see no problem with utilizing economic incentives to encourage this shift in behavior. Of course, that presupposes that alternative clinic settings exist. The cost must still be absorbed, but the more efficiently we provide this care the longer it will take for the system to deteriorate.

When you feel the rumbling of the train through the rails, it’s time to get off the tracks, no matter how nice a tan you’re getting.

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