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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