Mike the Mad Biologist

Revere proposes a simple healthcare plan: “Medicare for all.” He bases this on the finding that the healthcare outcomes of people aged 55 to 64 don’t become worse once they turn 65, even though that would be expected with chronic conditions. Why? Access to healthcare through the Medicare system:

If you have heart disease or diabetes and you are uninsured you are worse off than those who are insured by several measures. Those are the kinds of health conditions that usually worsen with age, too, so you would expect this to be a bigger problem for the uninsured near elderly. But they don’t worsen for this group because when they hit 65 in the US they are no longer uninsured: they have the near universal health insurance coverage called Medicare, and as a result their health improves.

…Before they were eligible for Medicare, the health of the uninsured near-elderly got worse faster than their insured counterparts, being significantly so by the time they hit 65. Those with cardiovascular disease and diabetes, however, reported significantly better overall health, mobility and heart disease outcomes after getting on Medicare. The improvement was so rapid that in a few years, by the time they reached 70, the expected difference in the summary health measures between the previously insured and uninsured had been reduced by half.

The implications are that earlier insurance coverage would vastly improve the quality of life for the near elderly.

I agree, but there’s another reason why we need a single healthcare system, and not our balkanized and largely privatized system: consumers (or as I quaintly like to call us, citizens) have no idea how to effectively price healthcare plans:

I had a total of seven different health insurance plans to choose from, three of which were HMOs. The HMOs were the most interesting: the most expensive was $173/month (for an individual), and the least was $118/month. As far as I could tell based on the benefits package, the $118/month was the ‘you are legally required in Massachusetts to have health insurance, but if anything happens other than an annual checkup, you’re hosed’ plan. But I could be wrong: maybe someone paying $173 per month is just wasting his or her money. Or maybe we’re both screwed if something bad happens.

….none of us have any way to evaluate if the insurance we have picked will provide the healthcare we need if something disastrous (or even mildly annoying) strikes. I have no idea if something bad happens (and there are many kinds of ‘somethings bad’) whether my plan will provide the healthcare I need. Would I have access to the specialists I might require? Which treatments would be covered, and for how long?

Realistically, I can’t determine that. That’s not a choice, it’s Russian Roulette.

In light of the horrible case in California where a patient was denied life-saving treatment by a private bureaucrat accountable only to his shareholders (as opposed to elected officials), the problem becomes even worse. Not only is virtually impossible to accurately assess the ‘best’ plan, but the lack of accountability means that even if I could figure out which is ‘best’, I have no guarantees that I will receive the healthcare I’m owed. At least with a government-based system, there is some accountability, even if it is imperfect.

Libertarian-troll-be-gone: For those who argue that the market will correct these problems, the only corrective in the California case appears will either be a really pissed off attorney general or a highly successful civil suit. That is, either a government regulator or a trial lawyer. I would enjoy the schauenfreude except for all of the dead people…

Comments

  1. #1 MarkH
    December 28, 2007

    Uhh, the market. Surely healthcare in this country is the sign of an egregious market failure (the libertarians will undoubtedly show up and blame it on what regulation we have).

    There are two problems here though. Medicare reimbursement of PCPs is not increasing, and they yearly threaten to lower reimbursement rates so the doctors on the front lines don’t feel screwed for not having a cost of living increase in a decade. Without PCPs healthcare sucks, and medicare will discourage MDs from choosing to be primary care or general practice docs because they simply refuse to reward the single most important doctor in any given patient’s medical care. The PCP is the diagnostician, the manager, the coordinator, who makes sure patients problems are prevented, detected, treated, while wrangling all the patients specialists to avoid redundancies in prescriptions and procedures. The failure of medicare to reward PCPs makes it so only a fool (or an idealist) would go into such practices, or ensures our medical system will be filled with foreign medical graduates. Either way, it bodes ill for the basic infrastructure of how people get care.

    Two Medicare practices many of the same obnoxious behaviors found in HMOs like routine denials, forcing docs to constantly appeal decisions over pennies. You either have to hire another employee to fight with medicare over reimbursement for 8 hours a day, or face the fact that beyond only reimbursing you for a fraction of what your time and work is worth, they will also routinely fuck you over approvals and micromanage your care.

    While getting more people care would be wonderful, unless medicare is restructured to reward PCPs and GPs for going into an underpaid yet incredibly important branch of medicine, the basic infrastructure will fail. And if you tell current medical students everyone will soon be under medicare? None will become PCPs. They’ve heard the stories, they know.

  2. #2 Kaleberg
    January 1, 2008

    The problem with primary care physicians is not just a problem with Medicare. Private companies pull the same garbage, and doctors need to hire entire staffs to deal with the various reimbursement forms and arguing for payment for treatment. In fact, if this problem is going to be fixed, and GPs better rewarded for their front line service, then it is likely that the change will come from Medicare, not the private sector. Medicare makes political decisions; private health insurers make economic ones.

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  5. #5 kısırlık ilacı
    February 3, 2011

    Private companies pull the same garbage, and doctors need to hire entire staffs to deal with the various reimbursement forms and arguing for payment for treatment. In fact, if this problem is going to be fixed, and GPs better rewarded for their front line service, then it is likely that the change will come from Medicare, not the private sector. Medicare makes