By Dr. Shelley Dworet, FAAP
President of Health Care for All Colorado
Back in the 1960’s when I first thought about becoming a pediatrician, I was in my mid-teens. I asked my own pediatrician, a woman who had known me since birth, if I could shadow her for a day. What an experience to watch her see patients at Brigham Women and Children’s Hospital in Boston, then follow her back to her elegant office in Brookline. Behind the closed doors of her private space, her desk was piled with charts and letters, and journals stacked on the floor and chairs. All at once, I didn’t feel so guilty about the state in which I left my bedroom that morning.
By Donna Smith
How could any of us see the photo of John Lennon’s blood covered eyeglasses released by Yoko Ono recently and not mourn the senseless gun related deaths numbering over a million souls since December 1980 when Lennon was gunned down? The right to carry guns and “defend” oneself seems to have trumped the right to be safe and secure when we walk down the street or send our children to school or see our teenagers off to work at a local pizza parlor.
We’re a tough, independent lot, eh? We like our freedom to dominate the rugged frontiers our foremothers and forefathers once did. We like our freedom to defend whatever it is we have deemed defensible with whatever means we have deemed legal for our selfish sensibilities at the time we feel threatened.
Yet, more than a million Americans have died since 1980 because they lacked access to medical care when they needed it – and mostly because they lacked the health coverage or the cash needed to buy that care. That’s using conservative estimates of 25,000 dead each year from 1980 to 2000 and 45,000 each year since then. Roughly 1,062,500 health care dead or about the same totals as from gun violence. Who mourns these dead? .
The purpose of this article is to demonstrate the differences between private insurance plans and public (social) insurance plans and how to use this information.
The structure of health insurance has been a topic debated since the early 20th century. The nature of health insurance and the financing of health care services are increasingly critical in view of the three challenges of cost, quality, and patient/community values. More recently, health insurance is utilized to control and reduce health care spending.
Patient, family, and community perspectives have primarily been focused on the indirect cost (lost earning and family life disruption) of sickness. The recent increasing medical care costs result in a focus of insuring against rising costs, and then become divorced from the social costs. The difference between patient perspective and private insurance company perspective is now defined.
The March 4, 2013 TIME Magazine Special Report by Stephen Brill1 “Why Medical bills Are Killing Us” demonstrates a series of narratives that describe problems in our health care system.
The focus of the article relates to the cost of health care services. He states that the responsibility for the health care cost problem is primarily with the insurance companies, DME manufacturers, hospitals (both for-profit and not-for-profit), and pharmaceuticals. The excess cost by and large is not related to physician and patient behaviors. Brill suggests that real solutions might be related to lowering the age for Medicare eligibility, and to implementing a single-payer system. He further states that these solutions are not feasible. Brill then offers incremental solutions that include tightening anti-trust laws, tax profits up to 75%, tax surcharge on all non-doctor hospital salaries, outlaw the chargemaster, amend patent laws, medical malpractice reform, and cap insurance payments for imaging.
By Donna Smith, executive director, Health Care for All Colorado Foundation
It isn’t often anymore that I learn a new word in the health care system discussion, but this week I did. Churning. I was at a meeting here in Colorado where I have taken on my new role in educating and administering for a publicly financed, universal, single-payer system with Health Care for All Colorado and for the Health Care for All Foundation. And the definition of churning I learned is a sad commentary on a system that still allows access to care based on inequality of coverage that leaves so many people suffering and tens of thousands dying in America every year.
Churning is the policy wonk term for those who qualify and are covered by a public program like Medicaid and who then have access to a private insurance plan through a new job that offers it or through a family member’s coverage but who then lose that coverage and end up back on the public insurance for which they qualify. They churn. And they suffer.
Churning doesn’t happen in an orderly or smooth way. There is a person with health care needs churning. There may be weeks or even months during which that person has no coverage and therefore only the access that money can buy them, and we all know how far that will go. Sometimes there are children involved who churn with their parents. Kids with illness for which they need care can suffer during delays of approvals for both public and private plans. How do we explain churning to a child up in the middle of night with asthma symptoms or other problems? “Sorry, sweetheart, mommy is churning this week, and we do not have the money to buy that inhaler. Maybe the insurance will come through next week.”
Those who have tried to transition from one private plan to another due to a loss or change of jobs will understand. It is stressful to make these changes even under the best of circumstances. Imagine that policy wonks discuss ways to reduce churning from public to private and back to public plans again when there is a clear and equitable way to end it for good. Adopting a sensible, equitable, universal, publicly financed, single-payer – Medicare for all for life – system would end all of this awful churning and the need for policy wonks to study and find ways to reduce it.
So, I do not like the word for which I just learned a new connotation. Churning. Let’s end it. And while we’re at it, take a look at the most recent study results that reconfirm that this system of ours is among the worst, not the best, in the world. Those engaged in our public policy and budgetary decisions consider what broader sorts of economic “churning” does to our system.
From the article linked above: “Policymakers must recognize the potential implications of current decisions that have to be made about public health and social programmes that are currently in jeopardy because of fiscal concerns,” Woolf says.
“Understanding how cuts to those programmes might help balance budgets will probably exacerbate the country’s current health disadvantage – and make greater demands on the system later on. We need to help them understand the larger economic implications, if not the human toll.”
People are suffering while we have the capacity to stop the suffering. Our community values would have us end that suffering if it was at all possible, and it is definitely possible. We need the will to do so. Let’s get on with that work.