We’ve also analyzed some of the sources of excess cost of US healthcare to other countries. What is uniformly true about universal health care systems is that they all spend less on medical care per capita than the US. The next nearest country in spending to us, France, spends 50% of what we do per capita while providing top notch care, possibly the best in the world. And while the cause of our excess costs are multifactorial, one of the greatest sources of excess cost is likely due to increased use of emergency rooms over primary care providers. We already have universal healthcare, if someone shows up injured or ill, hospitals are obligated to treat them. But forcing people to come to the ER when their problems have become critical increases the costs of treatment dramatically. Now a new paper in Health Affairs demonstrates the cost of ER use over PCPs and their findings confirm that as much the costs of the uninsured to the health care system dropped by 50% once low-income uninsured patients received health coverage. This is good news as it suggests as health care reform is enacted we should see huge savings just from having a universal system.
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In the paper, the authors studied the health care costs of 26,000 low income individuals before and after enrollment in a community health program in Richmond. After three years, total costs per capita dropped from $8,899 to $4,569 with concurrent drops in the number of ER visits (25%) and increased primary care visits (50%).
I’ve witnessed this problem first hand. Uninsured patients come to the ER with problems that were minor a week ago, but now are critical and will costs thousands of dollars to correct. The most egregious example I can think of was a patient with an infected boil that he ignored because he didn’t have a doctor or insurance. It eventually eroded through his skin as the infection failed to resolve after trying to put hot and cold compresses on it did absolutely nothing. When I saw him I could smell the rotting flesh from outside the examination room in the ER. The patient had to be admitted to the ICU as he was septic at this point, and needed IV antibiotics as well as an emergent operation to debride the wound. Followed by an even more expensive reconstruction since it involved his face. I would estimate the costs of his ICU stay, medications, and 12 hours of surgery were probably in the $60-90k range, and that’s a conservative estimate.
What would this problem have cost if he had a primary care provider? Probably 100-150 bucks. A PCP could have lanced this boil in office 2 weeks before, and maybe given him a short course of bactrim (an unnecessary use of antibiotics but a common enough one). The cost of the physicians time, a few alcohol swabs, some lidocaine and a knife would have been infinitesimal compared to the bill he racked up from not having insurance. Not to mention the pain, suffering, and shame he felt from how bad this problem got. And did he ultimately pay his bill? Nope. In the end we pay for it, with higher premiums, higher taxes, and higher medical bills for all. This is the hidden tax the uninsured place on us all. All Obama has done is acknowledged we pay this tax, and brought it out in the open, as well as requiring the irresponsible who don’t have health insurance and can afford it to buy it.
Sure enough, the evidence is coming in, the cost savings of having a universal system are likely to be substantial. It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated.