As President Barack Obama signed the landmark health care overhaul into law this week, it seemed appropriate that the person standing closest to him was an 11 year old boy. When health care fails, children often pay the greatest price -- whether it is babies born prematurely to mothers who cannot afford prenatal care; or toddlers who lack necessary immunizations; or grade schoolers who suffer in silence with asthma; or adolescents struggling to manage diabetes or psychiatric disorders without a guiding medical hand. For all of them, this new law will make a difference.
But as the chief executive officer of a children's hospital accountable for the care of 280,000 children through Medicaid, I worry that adding 15 million Americans to the Medicaid rolls -- as this reform bill does -- will have the unintended consequence of decreasing access to care for all children. Across America today, parents already face two to three month waits for appointments with pediatric specialists. Simply covering more children -- without ensuring a ready supply of pediatricians -- will only expand wait times and undermine effective care.
Today, Medicaid provides comprehensive coverage to 57 million low-income Americans, almost half of whom are children, who would otherwise go without coverage. One of the reasons Congress chose to cover more uninsured families by expanding Medicaid is that it's cheaper than going through private insurance. That's because Medicaid typically reimburses doctors and hospitals below cost -- paying about 70 percent of what Medicare pays for most procedures. That is astonishingly low given that most members of Congress consider Medicare rates too low to provide seniors with adequate access.
In large part, Medicaid is a program that relies on the goodwill of pediatricians who love what they do and are willing to work for much less to serve children and their families. Unfortunately, Medicaid -- and the doctors who deliver it -- are beginning to buckle under the weight of impossible circumstances.
Pediatricians are caught between upward pressure on demand and downward pressure on cost. In states from California to Michigan to Georgia, doctors lose money with every Medicaid patient they see. As medical practice costs outpace reimbursements, an historic number of pediatricians are being forced to reduce the number of Medicaid patients they see -- or, in some cases, stop seeing them altogether.
As a result, many low-income families -- who are already hard-pressed to take time off from work and pay for transportation -- struggle to find a doctor. With 15 million additional Americans added to this already-desperate situation, we not only risk longer wait times; we risk making Medicaid a hollow promise: a safety net so shot through with holes that it provides little to no benefit to needy families.
The reform bill signed by the President begins to address this problem. Starting in 2013, the federal government will help states pay primary care doctors under Medicaid at the same rate as Medicare, which will provide welcome relief for many doctors. But a provision to equally reimburse pediatric specialists -- who account for a small but important percent of care under Medicaid, and often have months long waiting lists -- fell out of the bill during the last weekend of negotiations.
To improve the health care delivery system for children, Congress should find another vehicle to reimburse pediatric specialists at a rate that is at least comparable to Medicare. Otherwise, we run the real risk that the new health law will come in conflict with the law of supply and demand.
In addition, Congress should require that Medicaid increase payment to hospitals. Ohio children's hospitals alone lose more than $200 million each year in Medicaid reimbursements that fall far short of expenses.
Pediatric care should be recognized as an essential investment in our nation's health. Research shows that children with health problems like obesity, asthma, and diabetes go on to face a lifetime of chronic illness. At a time when chronic illness drives 80 percent of America's health care costs, ensuring full access to pediatric care is the best long-term strategy to bend the cost curve and build a sustainable health care system.
It is not written in stone, and that is one of the positive sides to HCR Law.
Many significant changes can happen to this bill before it fully kicks in, 2013/14.
Reform comes in many sizes and this HCR Law is not perfect, like people.
their are many flaws. But there is now something, a foundation to work with.
If the bill did not pass, Health Care Reform would not be looked at again
by either party in the foreseeable future, and we would have absolutely nothing.
What is interesting is to see who will work to improve this legislation to make it a
better Law for the people and reign in the Corporations who hijacked it for profit. And
who would rather Repeal it, wasting time and resources for a cause most certainly to fail.
Every year a door opens and you can enter it or stand back and continue to
accept what is, because it is to hard to change the system. You can be in it for
the long term or continue to resist change for reasons only you know to be true.
We have false choices with the present dysfunctional system. The terminally ill uninsured get nothing and no resources like hospice care, or, we wait till they are so deteriorated, summon an ambulance, and without an advance health care directive, are given a code blue, intubated and worse, fated to die of their disease in the ICU which I call a "high tech hospice" .
Every day, these scenes are repeated for the terminally ill child or adult to the tune of several hundred thousand dollars before he actually does die. Our system is so short-sighted that these fool's errands are commonplace. Ask any critical care nurse or intensivist about rearranging the deck chairs on the Titanic.
Please go to my website soonerorlaterbook.com to learn more. I was that critical care, emergency, nurse practitioner for 23 years. Sincerely, Damiano de Sano Iocovozzi MSN FNP CNS and Drew Johnson, The Thomas Edwin Walls Foundation
Please let me know what week this will happen.
Speaking hypothetically, if the government becomes the "single payer" for all medical care, would you imagine they would pay more, the same, or less to health care providers than they do today for Medicare and Medicaid patients? How would you like to have the entire system paid for by the government? Being a doctor would be a great profession then, right? Working incredibly hard during long years of school and in an arduous profession afterward is still worth it if you make about what a second year MBA makes, right?
Can't you sell $1.00 bills for $.65 and make it up in volume? Oh sorry, not supposed to do volume. Detracts from quality of care.
If the US started offering loans for doctors with 0 interest as long as people stayed in the US and practicing, and no payments until after residency, you might see medical costs go down significantly. Of course those loans have a cost, but the net gain would be worth it I think.
Employers could optout of paying for or being involved with health care which employees would receive for free from the Public Option.
Public Option users would never have to pay another insurance premium, medical service co pay fee, or any prescription costs and everyone who wants it could have it no restrictions.
An amendment to the new bill that would add a Free Public Option, run by the government, which eliminates insurance companies and uses sales taxes to pay for care which would then be delivered free from government hospitals, could produce the drastic cost savings which will be required to save us from the horrific costs of the new bill and existing mandated programs.
The easiest way to create a true Public Option, and the only way to cut costs, is not to use the Medicare model, which still brings the private provider high cost baggage with it, but instead to use the VA’s model of government staffed hospitals, and to use sales tax funding instead of insurance, to create a new stand alone system.
Medicare and Medicaid could easily be salvaged without bankrupting the federal government by using a Public Option system to deliver all care and medications to all recipients totally free and at a fraction of government’s current costs now devoured by private systems.
What part of the public sector do you work in -- teacher, DMV, police or fire? Only in the public sector do we find such rampant economic ignorance.
You do realize that we all are paying right now... but the least fortunate pay the highest price. Why is that?
Single payer, however it's paid for, will not affect your cushy lifestyle one iota.
You won't have to give up anything... so, why are you against helping the sick and suffering?