You Get What You Don't Pay For

Courtesty of Grunt Doc

Govt program a strain on U.S. emergency rooms: study

"Researchers at the University of California San Francisco and Stanford University found that the uninsured patients paid 35 percent of their overall emergency room bills in 2004, versus 33 percent for Medicaid."

And...

"According to the Centers for Disease Control and Prevention, the number of hospital emergency departments fell 9 percent to 3,795 from 4,176 in the decade leading up to 2005. During that same period, the number of annual emergency room visits increased by nearly 20 percent to 115.3 million.

People on Medicaid -- a $300 billion federal and state insurance program that covers 58 million adults and children who are poor or disabled -- visit emergency rooms at the highest rate, according to the CDC."

They are followed by patients covered by the government's Medicare program for the elderly, the uninsured, and finally, people who are privately insured."

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No freakin' kidding. How about that. I could have told you that 4 years ago.

So is it because Medicaid and Medicare patients are sicker?

Really?

I would have no problem accepting that answer, if not for the fact that people with NO insurance came in third. Not first, not second, but third, Right in front of those with private insurance. One would conclude based on this answer that either Medicaid/Medicare patients receive worse care than those with no insurance resulting in more emergency trips to the ED (which would bolster my argument for a cash only system), OR they utilize emergency rooms more often because they are losing access to primary care physicians. Either way, it is a loser system for all involved; patients, doctors, and Uncle Sam's checkbook.

I can tell you the reason why it's happening. And it won't cost you a dime.

Money, money, money, ( see any of my previous posts about this). Let my take you down my extensive highely thought out path of logical conclusions.

FREE=MORE UTILIZATION.

EXPENSIVE=LESS UTILIZATION.

There you have it folks.

Those without any insurance are rationing themselves. Without a doubt, something which so many feel is taboo to talk about. Is it wrong? Of course not. Not everyone can drive a Lexus and eat lobster.

On the same level, I also ask, is it wrong to flood the ED system with free unlimited utilization? I can say absolutely with out blinking an eye. Yes.

You have just graduated from Common Sense University. Government money (ie Medicare/Medicaid) works on the principle of :

FREE TO THE PATIENT= MORE=MORE=MORE=MORE=MORE=MORE=MORE (endless loop) which translates into... BANKRUPCY OF THE SYSTEM. In an effort to prevent the natural human instinct to get more for free (the American way), they (your trusty Congress) have tried to cap the systems costs by reducing the value of each individual service.

How about that idea of universal care. That single payer system. You know, Medicare or Medicaid for all...pick your poison, it will kill you either way. Having insurance for everyone will flood the system with utilization. If you get free care, you will use it and use if often. If you had to "pay for it", it wouldn't be called universal now would it. It would be called rationed care. And if everyone gets free care, everyone will have restricted care. And that would still be rationed care. So rationed care for all. How quaint.

Because we have more utilization with no end in site, these free programs have priced themselves out of reality with primary care. In a feeble attempt to control their costs, they have reduced the value of each individual encounter to rubble. It has devalued the time between you the patient and your primary care doc.

Your primary care doc has been pummeled. By nature of the system, the fixing of the pot of money, your medicaid/medicare entitlement that you feel you have (free care everytime, all the time), has priced you down below the range of a sustainble rate of reimbursement for your practicing primary care physician. He is exiting that pot of money you so dearly need, the pot of unrestriced access to all care, all the time. The pot that those without insurance seem to be doing better without. The pot that those without insurance have never had access to.

If in fact our goal for America is to insure every man woman and child, you will be left with insurance for all, and doctors for none. You can't promise everything to everyone. Look only to medicaid for the reality of universal coverage.

Without primary care, where does one go?

ER. The first line of defense for Medicaid, and coming to a neighborhood near you, Medicare.

Primary docs have left the Medicaid system. ER docs, in forced servitude already by the nature of EMTALA laws have become the unwhiting owners of the primary care backlash. And it's because the glorious model of human nature: FREE=MORE.

However, with its decreasing reimbursments, the end result of the FREE=MORE policy has become FREE=LESS. ER's are closing. Primary care is leaving. In a massive run for the exits.

ACCESS DENIED.

Hello Congress? Is anybody home?

But how could this be? Free insurance, and no where to go. Universal care in a nutshell.

Market forces will always win. Human nature says so. You want more for less. The market will decide what you pay.

Do you wan't to know why private insurance utilize ED's less? Because they are extremely expensive. Most policies have built in $500 or more ED deductables. In other words, you pay $500 bucks before your insurance kicks in. That is a self rationing. And you do it all the time.

Chalk one up for Blue Cross. Winner of the billion dollar profits by your own self rationing.

Medicaid, Hell no. Medicare? Hell no. FREE =MORE rules the world in their fantasy economics.

Double whammy for ER. More utilization governement insurance that pays pennies on the dollar of their service. ER will go (is going) the way of primary care. Critical access lost. Primary care lost. A system in shambles. Your specialist will be the last survivor, but will die as well, given time.

Welcome to that pot of money forcing unrestricted access in an ever restricted pot. FREE=MORE


My solution.

Turn FREE=MORE----------> FREE=LESS.
Turn EXPENSIVE=LESS----> EXPENSIVE=LESS

Decompress the pot. Overt rationing. Nothing to hide. To stem the cost of care, you will only succeed by placing a very high burdon of self restraint on the shoulders of the patient. A personal interest in their own consumption of system resources (which will never be unlimited).


And money my friends is a very effective tool of .

Overtly ration consumption, but let the patient decide. This pill is not so hard to swallow when you have a choice to consume, not a mandate not to consume. Make it worth your while for that ER visit. Your $100 medicaid copay will force you into tough decisions. No free ride. The system cannot afford you anymore. You are bankrupting the system, and taking everyone with you.

It's time to say no more.

Rule #1. Decompress the pot with overt consumer rationing.

Rule #2. Expand the pot with overt consumer expenses (aka cash; aka, high deductalbe HSA, aka big honkin' copays). You must pay. No more free ride. The government pot is bankrupt and paying your specialists for their expensive procedures/imaging/surgeries.

Fix primary care, and the system will fix itself. That is my theory.

Expand access to primary care by following rules #1 and #2.


I am convinced using common sense, that if you allow physicians to compete with each other openly, based on price, that the appropriate price will be set and the appropriate utilization will be consumed. Not free all the time. Turn free into less by rules #1 & #2.

Turn FREE into EXPENSIVE for the patient, not the sytem, and you fix the sytem. Only then will you cause a massive shift in the entitelment mentality and force upon this country the necessary evil.

Grow some balls Congress.