I'm Covered. Now What?

During the last couple of weeks, much has been made about the release of healthcare plans by the three leading Democratic presidential candidates. Each of the top tier candidates released significant plans to achieve "universal coverage" -- putative plans to provide coverage for the uninsured and the so-called under-insured.

For the most part, plans released by Sens. Hillary Clinton and Barack Obama and John Edwards are similar in purpose and in method. They involve some combination of the expanding the health program that covers Congressmen and an expansion of Medicare.

And they're absolutely on target when they say universal coverage is not only a moral imperative, but will help contain costs in the long run. But that only solves half of our monumental healthcare problem.

Because there's more to healthcare than just being able to pay for it -- if someone can't find a doctor, what's the use of having coverage?

Consider this: 24 percent of Medicare patients who are looking for a new primary care physician are already having difficulty finding one to begin with, according to MedPAC, the government commission that advises Congress on Medicare issues.

That means that a quarter of people who already have full coverage through Medicare -- somewhere around 11 million people -- can't use that coverage because they can't find a doctor in the first place. Let's assume that the presidential candidates' respective plans actually are able to provide coverage to the 47 million Americans who do not have it today. Where will they get treatment?

In other words, we've got ourselves a whole new doughnut hole: millions of Americans who have full healthcare coverage, but can't use it anywhere. With reimbursement rates in the basement, and medical students flocking to specialty care, the shortage in primary care physicians is growing to an unmanageable size. Even the insured can't find a doctor.

So (with all due respect to Huff Po-contributor Bill Maher) new rule: for every time presidential candidates bring up universal coverage, they must also talk about universal access. Because there's no point in universal coverage to pay for doctors that don't exist.

As it stands right now, we're not putting the cart before the horse, we're putting the cart without the horse. Yes, universal coverage is absolutely necessary. But unless we address the access problem, we'll mostly just be paying a lot more for the same amount of medical care. This is just how far backward our thinking has become when it comes to healthcare reform.

It's high time that our politicians realize that the healthcare crisis in this country is a two-part problem that requires a two-part solution. And they better start talking about it too.

Unfortunately, the presidential candidates haven't yet gotten the message that access, in the form of primary care doctors, plays an equal part of a two-pronged solution. In Barack Obama's healthcare plan, primary care appears once. Edwards' plan mentions primary care, but only while talking about coverage for preventive medicine. In Clinton's plan, primary care is nowhere to be found.

President Bush talked about access in Cleveland, Ohio this past July. "I mean, people have access to health care in America," the President said. "After all, you just go to an emergency room."

Given that kind of rhetoric, maybe we should be thankful that the Democrats are at least putting forward some comprehensive ideas to address 50 percent of our problem.

But to be clear, if any of the Democrats' plans go through without a correlating solution for access, the advice that President Bush gave will be the only available option to millions of Americans -- and that means far higher costs and far worse health results.

A lack of access is the reason healthcare costs are skyrocketing out of control. It's the reason we have record rates of chronic diseases like asthma and diabetes. And it's the reason we'll still have a healthcare crisis in this country, even if everyone has health insurance.

Comments

[Trittydi]

What about the fact that we're covered but can't afford to use it?

We are covered through my husband's company (very costly) but cannot even consider routine medical care or even the dental that is also provided.

The deductibles for both doctor visits and prescription medications are prohibitively expensive. We would be covered in an emergency - other than that - we're too broke to use it.

America - the greatest country? I DON'T think so - a mere illusion. People believe that because out elected representatives and bought and paid talking heads say it is so.

America sucks.
*

[FrustratedDemInNH]

Just getting covered can be a real nightmare. I am and insurance agent, and have trouble with coverage.

We finally settled on a plan whereby my wife would take coverage through her work ($85 per week just for her...if she extended it to her family it would have sky rocketed to $220 per week...and oh, she works for the school district), I would get a high-deductible plan...$5,000 deductible for $290 per month less my 20% commission, and my kids would rely on SCHIP at $90 per month. Yep, we are one of those "wealthy" families Bush and company are trying to eliminate...we make about $85,000 per year after expenses, etc.

So, after taxes we take home about $60,000, pay out $30,000 in mortgage and property taxes, and have a whopping $30,000 a year to live large at the expense of the American tax payer.

Piecing together health coverage only takes about %26 of our take home pay.

Gotta go...have to hop on the ol' private jet and make it to Cannes in time for my squash game with the prince, all the while gloating about how I am taking advantage of the system.

[weslenforever]

It's about time someone brought up the obvious. I am disabled and have medicaid. more than half of the primary care physicians in my area have closed their practice for private jobs, head of a hospice or other, or have retired just since the last cut in reimbursement and my state and the federal government are both planning another cut before the end of the year. My doctor of the past 3 years closed his office in July and I am unable to find another. I have many health problems, including heart, circulation, recurring internal bleeding, etc. The time will come when I will no longer be able to see the specialists who are crucial to my life because there will be no PCP to give me the referrals. None of the PCPs who are left are taking new patients or they're just not taking new medicaid or medicare patients.
When I heard about the next cut in pay to these doctors I wrote to every senator and rep. in both the state and federal gov and the governor protesting more cuts. I suggested they take a pay cut instead OR give up their expense accounts, OR fire all the aides who "do ALL your reading and MOST of your thinking for you and do your job yourself".
We tax payers(sorry, I'm no longer a taxpayer since my first bypass) are paying half a million dollars a year for Cheney to drag half a dozen cardiologists around with him everywhere he goes and he has the nerve to say people like me don't deserve the same. I'm just hoping that he dies before I do because I will take every dime I have to travel to where ever he is buried and SPIT on his GRAVE.

[photon's feather]

There is no reason that we ought to be forced to support insurance companies. As already pointed out, that is an unnecessary expenditure. I don't have to read any reports: the cost of seeing a doctor would drop about 25-30%, if no insurance were involved.

How do I know? I am not insured. When I go to a doctor, I am routinely offered a 'discount for the uninsured.' This is not a charitable offer, but merely reflects the savings to physicians in not needing to pay staff to fill in and submit medical claim forms, and follow up on late payments, field any number of phone calls from the insurance company; and, in addition, the time the physician himself might have to spend on the phone arguing with an insurance company about whether or not something is covered, as well as possibly needing to fill out additional forms. Once the self-pay patient says 'Yes,' the procedure is approved. (The biggest problem with self-pay is, of course, that a limited budget - like mine - means limited medical care, even at reduced rates. However, my budget wouldn't stretch to insurance coverage under any circumstances.)

For those who say that this puts unnecessary responsibility for researching medical conditions/treatments, my answer is: that is no different than the situation now. In my experience, the rate at which physicians currently do procedures that are not medically indicated is alarming. (There are too often ways around insurance company 'safeguards.')

[realitytrumpsbull]

Healthscam, healthcare, healthscare, it's all
a big moneymaker, if you can't pay, they'll leave you to die in the street...

[kirkland]

Thru personal family experience I can say that in the expensive North East Corridor ( NY, CT, NJ) the number of MDS in ALL specialties who have opted out of Medicare is *VERY* high. This of course affects the elderly but also the disabled who cannot receive medicare for their disabling conditions. It is incredibly distressing and I often wonder how it is that our leadership are SO UNAWARE that in many cases? Medicare means no care. Nada, Zip.
( I'm thinking of someone with a disabling liver condition, spine condition who needs physiatry , immune system condition and several elderly people whose MDS no longer *take* medicare. It is phenomenal to me that there is no resource for these people. ( other than to go to the ER when they are VERY sick- in medical crisis - which they do. Americas most vulnerable citizens ( elderly and the disabled) have BEEN ABANDONED. It is my hope that somthing opens the eyes of those drafting new plans- it is catasprophic.

[PKSSK]

The lack of primary care physicians is becoming an epidemic in this country. As this thread points out, the lack of physicians will be the largest threat to the health of future generations. Also, because health insurance will be mandatory in order to pursue employment and education, there will be many who will fall into poverty. The future generations of this country will be the ones to suffer the most, as they will not be able to afford an education, health care and social security will be non existence.

Only the future generations of the corporate elite will survive.

[slc20]

Hillary Clinton's and John Edwards' plans both MANDATE insurance.

That means you are forced to buy it, or you're breaking the LAW. You can't get a job, either, unless you show proof of health insurance.

Well that may sound fine and dandy until you find out that you can't AFFORD said unsurance, but aren't poor enough to qualify for gov. help.

Romney has a similar plan in Mass. and the cost for a SINGLE MAN for insurance is $600 per MONTH!!!

The problem isn't solved by making it illegal to not be able to afford insurance. It's to make Insurance affordable.

Hillary's plan is a gift to the insurance companies that have been lobbying her.

[JudyGee]

I can't even afford medicare insurance. Healthcare should not be affordable, which is a bullshit word that will lead us to the river styx, it should be no cost. Why are we paying anything for any of this. In a real universal health plan, as in canada or england, Ireland, doctors are available and accessible, you have a medical card and there's no charge. And, no insurance company. As soon as I heard Clinton mention insurance co's I knew, uh oh.
Anyway, we won't have jobs, which at least solves the problem of going to jail.

[weslenforever]

Last time it was putting everyone into HMOs just about the time we were learning what a disaster they were. The first time I heard HMO in connection with her plan I said "NO WAY".

[kasa5400]

If you are going ot make up things - don't.

(1) "You can't get a job, either, unless you show proof of health insurance."

Nope. Not true and it is not in either proposal.

(2) "Romney has a similar plan in Mass. and the cost for a SINGLE MAN for insurance is $600 per MONTH!!!"

The MA plan is the pits in terms of coverage put that is a LIE about the cost.

Male under 29 = $125-150
under 40 = $175
Under 65 = $350

Of course those are the lowest rates with no prescription coverage, a deductible of $2000 per individual and a total out of pocket of $5000.

But it is still a LIE to say that ir costs $600 a month.

The truth is damaging enough so why lie?

[Kansas Evans]

Thanks for the reality check. I hope your message gets to the candidates.

[Pdubya]

"insurance", whether corporate lobbyist, or federal mandate (both interchangeable) is what makes healthcare expensive. how many middlemen must we insert into the sytem to realize that is whats bankcrupting us?

[LindaJay]

I agree. Most of the healthcare plans I see being espoused seem to be aimed at reassuring the insurance companies, when I think they are a big part of the problem. That's why I would prefer to see us simply go to the single payer plan that Dennis Kucinich is talking about. Let's get the profit out of the health care system and we can immediately cut out a lot of the unnecessary cost.

[Pdubya]

well, you get to spend my tax dollar over time, as the value of the dollar goes down and the inflation of the subsidized product goes up.

welcome to Amerika