Health care reform is a hot topic in Washington DC again and none too soon as we see primary care numbers continue to dwindle as our professional lives become increasingly untenable.
An article in the New York Times today describes behind-the-scenes negotiations in the U.S. Senate. Senator Ted Kennedy is focusing the efforts of key stakeholders who are collaborating at an unprecedented level to achieve universal health insurance coverage. Achieving universal coverage is a huge goal and one deserving our full support.
I have concerns, though, that Insurance For All fails to address major structural problems in health care.
1: With diminishing primary care capacity and primary care already stretched to the breaking point, where are 47 million more Americans going to get their care? If this experiment replicates what happened in Massachussets, many will end up going to emergency rooms for care - the worst possible setting for exacerbating costs, unecessary testing, lack of follow-up.
“It’s a recipe for disaster,” Dr. Sereno
said. “It’s great that people have access to health care, but now we’ve
got to find a way to give them access to preventive services. The point
of this legislation was not to get people episodic care.”
In Massachusetts Universal Care Strains Coverage NYT April 5, 2008
2: Having health insurance does not guarantee access to health care. 25 million Americans have insurance and can't really use it.
In terms of access problems and financial stress, underinsured people—even though they have coverage all year—report experiences similar to the uninsured. More than half of the underinsured (53%) and two-thirds of the uninsured (68%) went without needed care—including not seeing a doctor when sick, not filling prescriptions, and not following up on recommended tests or treatment. C. Schoen, S. R. Collins, J. L. Kriss, and M. M. Doty, How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007, Health Affairs Web Exclusive, June 10, 2008:w298–w309
Make no mistake: I fully support universal coverage and even the first step of "insurance for all," but we must remember that this alone will fail to solve the structural problems we have in health care today. Effective primary care improves population health and reduces the per-capita costs of health care. America will move toward having a high performing health system when it couples universal coverage with a payment model that supports effective primary care.
L. Gordon Moore MD February 20, 2009
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