Posted by Guest Blogger on Fri, Dec 04, 2009 @ 05:00 PM
By Wesley A. Curry, M.D.
I'm not the first healthcare professional to point out that this country already has variants of a "public option" in health care. The Senate's latest rendition will hopefully reverse a trend and not further burden hospitals and ER physicians with more uncompensated care. But the fact is any new program will be the "fifth" public option since 1965. And each one has ultimately increased the economic challenges on the emergency care system.
The existing public option variants are Medicare and Medicaid, both established in 1965 and both obviously financed by tax payer revenue. Another is the Health Maintenance Organization Act of 1973, which gives HMOs certain economic advantages including the ability to force non participating physicians and hospitals to accept lower reimbursement for treatment of HMO patients. Lastly there's the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986, an unfunded mandate that ensures public access to emergency services regardless of the individual's ability to pay.
Medicare and Medicaid patients are becoming less desirable to healthcare providers because of decreasing reimbursement rates (legislated decreases or because rates have failed to keep up with inflation). That means more people are coming to hospitals under the mandates of EMTALA. The problem is, it remains unfunded and is the "last resort" for people without health care. Their default option then becomes the hospital ER.
Emergency care providers and hospitals can ill afford to have another "public option" that does not adequately reimburse primary care physicians and specialists. Increasingly hospitals have had to make up the difference and provide financial support for emergency care providers and on call physicians. Some hospitals have closed and the number of emergency rooms has dropped nationwide as the average reimbursement continues to decrease for patients in emergency rooms.
A fifth public option is a good thing for the country - but only if more people get access to primary care. The covered services must be limited and tort reform needs to be included, because whatever form the public option takes, the benefits won't be equivalent to the best commercial insurance plans which are quite expensive in comparison. With more people covered by medical insurance, the rise in cost will be mitigated if the hospitals and health care providers don't have to factor in significant losses from uninsured and underinsured patients. There is no free lunch and no free health care. I would appreciate hearing your thoughts and comments.
Posted by Guest Blogger on Wed, Dec 02, 2009 @ 06:27 PM
By Mark Spiro, M.D.
As an emergency physician who lives and works in California, I've been watching the never-ending budget stalemate with trepidation. Now that the plan is complete and the dust is starting to settle, it's clear that health care services will be taking a hit.
The New York Times reports that Democrats largely rejected the governor's initial plans to eliminate social safety net programs such as Healthy Families and the Children's Health Insurance Program. However, yesterday's budget plan still includes substantial funding cuts for health services. Under the agreement, the state would cut funding for Healthy Families by $144 million, which would place many eligible children on a waiting list. Capitol Weekly reports that total funding for the program would drop by $226 million.
According to Capital Notes, legislators also agreed to cut $1.3 billion in spending from Medi-Cal, California's Medicaid program. In addition, the state's In-Home Supportive Services program stands to lose millions in state funding under the budget plan. Under the budget plan, HIV/AIDS programs also would lose a significant portion of their funding, says the San Francisco Chronicle.
It's still unclear what these cuts will mean to hospitals and health care providers on a day to day basis, but I think it's obvious that we're going to be in for an uncertain - and sometimes - wild ride.