Update on the healthcare battles
Sometimes, the topics for editorials come right to us, within the stories we post. This week, two surveys, and a report from Massachusetts, dovetail to present a clear warning-sign for healthcare reformers.
The bottom line is trifold: (a) patients are spending more time in emergency rooms, but enjoying it a lot less; (b) even many of those who already have insurance coverage would rather clog emergency rooms than deal with their assigned healthcare providers; and (c) those who are the most essential participants, if reform efforts are to succeed, are among the least likely to participate in the programs willingly.
First off, based on a survey done by the U.S. Centers for Disease Control and Prevention, the number of ER visits went up again last year; in fact, the results show almost a 20 percent increase (to 1.2 billion admissions) over a previous study five years ago. According to an MSNBC article, this can be attributed mostly to the graying of America, and the rising extent of Boomer-generation healthcare usage, or as they put it, “The reason is clear — Americans are getting older.” They quote a CDC official as giving this summary: “When you reach 50 things start going wrong, just little by little, and you keep going back to the doctors.”
Meanwhile, according to another survey, conducted by Press Ganey Associates, Inc. (defined as “the healthcare industry’s leading provider of measurement and improvement services”), the average time per visit being spent in emergency rooms has continued to rise, with “significant variations by state,” as they summarize it. According to their figures, the average ER patient experience lasts four hours, up 18 minutes from last year. Moreover, in larger hospitals, the ER time goes up another half-hour for every additional 10,000 annual patient-visits. The range varied from just over 2-1/2 hours, to almost 6-1/2 hours in the worst cases.
State by state, the top ten fastest ER times were found in these cities: 1. Milwaukee 2. Indianapolis 3. Columbus 4. Oklahoma City 5. New Orleans 6. Detroit 7. Nashville 8. Cleveland 9. Kansas City 10. Chicago. Meanwhile, on a statewide basis, the bottom-feeders in the survey included Kansas (46), Virginia (47), Arizona (48), Nevada (49) and Utah (50). A copy of Press Ganey’s 2007 Emergency Department Pulse Report: Patient Perspectives on American Health Care report is available at http://www.pressganey.com/ER-report.pdf and upon request.
And in the final story, a Boston Globe analysis of young, healthy adults in Massachusetts shows few if any who are willing to jump into that state’s mandated health insurance pool, thereby (with their absence) guaranteeing skyrocketing rates for those older citizens who do enroll, given the realities of actuarial calculations on mortality and risk management. The story interviews one 30-something fellow, a juggler whose act includes performing while astride a tall step-ladder, noting that this lad refuses to provide a safety-net, either literally or figuratively, for his endeavors, since he “has been without health insurance for about a decade and cannot remember the last time he saw a doctor.”
As is noted in the editor’s note attached to that story-blurb on these pages, “The failure to at least get periodic checkups is a major factor in ending up with a surprise ailment, too late for a cure. Meanwhile, by engaging in hazardous behavior, with no regard for at least some ’safety-net,’ this idiot is just an accident waiting for others to pay for it!” If one chooses to engage in dangerous behavior — whether it be hanging from wires or chain-smoking, skydiving, binge-eating … or refusing to get some assurance of continued good health via regular checkups – one should be expected to pay the freight for such stupidity.
According to the article, though, “many young people partying and working near the Marketplace on a recent night were not sold on getting insurance. As they smoked and talked outside the area’s bars, most of those without insurance said they opposed state-mandated coverage. Many were worried about how they would pay the premiums. Others said they would not skimp on beer or move to a less expensive apartment to pay for healthcare.”
In other words, none of them were willing to take on the self-responsibility of taking care of their own wellness, and doing the minimal things required. Or is that really the case? We can’t tell from the article; the question is never phrased that way. All we know is, these young folks don’t want to cut back on their other expenses just to pay for health insurance they don’t need right now; we have no idea how many of them (other than the juggling fool) might be paying out of pocket to see a healer for regular checkups, setting aside something in case of emergencies, eating sensibly and limiting risky behavior, or otherwise making themselves less likely to become a charity-case down the line.
If these vital youth had their choice, they might be quite willing to take on a little low-cost, catastrophic-only coverage, coupled with a medical savings account in their own control. The Massachusetts wonder-plan doesn’t offer this as an option, however, so we may never know how that would have sold to these vibrant souls.
But the real question here is, what can we learn from these three stories? Well, to begin with, there’s the obvious fact that Emergency Rooms are still the preferred venue for far too many people in need of healthcare (while, more than likely, the vast majority of these folks do not NEED emergency care). It is always assumed that this represents the uninsured, and is thus a valid basis for agitating for universal ’single-payer’ health insurance. In reality, the CDC study found somewhat different results: “The report found that 46 million of the visits made to ERs in 2005 were by people with insurance, compared to 19 million by people without insurance.”
In other words, even among the already insured, many still choose the ER over a regular doctor’s office when they are in need of health services. Whether this is due to overbooked individual physicians, poorly run clinics that chase away patients, refusal to play the “co-pay” game or some other factor … that question doesn’t get addressed in either of these surveys. Clearly, though, the bulk of the problem of long waiting times in emergency rooms is not just a factor of the uninsured among us.
However, if we look at both sets of data, something does begin to emerge. Breaking out of the mindset that this can be fixed by insuring everyone (just wait to see how many flock to the ER when it not only doesn’t cost anything but is just as good or bad an option as seeing your own doctor!) is mandatory, if we are to have any hope of improving the situation. Finding ways instead to encourage people to do the right thing, and to give them incentives for self-aware living … there lies the pathway of the true healthcare reformer.
