Sunday, August 7, 2016
For
Whom Does the Health Access Bell Toll?
No man
is an island, entire of itself, a piece of the continent, a part of the main…I
am involved in mankind; and therefore never send to know for whom the bell
tolls, it tolls for thee.
John
Donne (1572-1631), Devotions upon
Emergent Occasion
Recently I had a
house guest a friend of my son, who had served as an
administrator for Medicaid in New York City and who now administers research
funds for a New York City academic center.
He and I discussed the American health system at
length. Although we did not agree on most
things, we did agree on one subject: the
problem of access – how to best provide access for whom and to whom.
A Tricky Proposition
Access to health care is a tricky proposition. For example,
universal insurance does not mean
timely universal access to care. This is true because many physicians do not
accept Medicare and Medicaid patients.
And even when they do, shortages of physicians leads to long waiting
lines, to postponement of procedures from months and even years, and
, in the case of the Veterans Administation death while waiting.
Timely Access to All Not Possible
Give the lack of resources and personel, no nation,
no matter how wealthy or well intentioned cannot provide timely access to all of the people
all of the time. Medicare, Medicaid,
the VA, ObamaCare, and U.S, hospitals (which must
accept the needy and the sick) now theoretically
provide access to roughly half of the U.S, population through a variety of
programs. Progressives insist with
universal coverage and with doctors on salary in large integrated systems, the access problem would go away. But even when health care is declared a
basic human right and everyone is under the thumb of government, access does not go away.
You can offer all the federal programs you want,
all the community health and Indian health clinics you want,
all the incentives you can devise to incentivize doctors to
serve in underserved areas.\.
all the telemedicine
services you can think of, people will seek the best care, the most advanced
technologies, the quickest access to the
best doctors and best facilities the country
has to offer.
This is true of all developed nations, even those with
guaranteed universal coverage supported
by hefty taxes and an expanding safety net.
With the Internet and the galaxy of social media outlets, people now have the ability to seek out the
best services, online and offline.
To expand personal access and to avoid unaffordable costs, people will frequent retail clinics, will
indulge in self-care and alternative medicines, will embrace probiotics and herbal
remedies, will go to the Internet to
find answers, and will go to concierge private physicians in search of personal attention. A third and even fourth tier of health care
will involve, centered on patient engagement.
The compulsion to
provide welfare for all and sprawling bureaucracies and countless regulations will not solve
access problems. It will simply make
access more complicated. People will
seek out the best care.
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