Wasting resources leaves us with Band-Aids
The Inquirer
Sep. 17, 2004
Waiting list for health care surges in Pa.
By Marian Uhlman
The waiting list for adults trying to get cheap government health coverage in Pennsylvania has jumped by a third since February, and in July topped 100,000 people for the first time, setting a record for the two-year-old program.
Experts see the surge as indicating a further decline of health insurance paid by businesses, which have been gradually cutting back benefits and raising costs for workers for several years.
The Pennsylvania Insurance Department launched the adultBasic insurance program two years ago in response to the growing ranks of uninsured adults.
The program dwindled to 37,000 people in August - the lowest number since November 2002 - because of budget uncertainties earlier this year.
The enrollees make too much money for the government’s medical assistance
program, but their income is too modest to pay for private insurance.
About 97,000 people are… on the waiting list, according to the state Insurance Department. The wait has been about 16 months. About 10,000 more people apply each month.
AdultBasic “is a Band-Aid,” said Kate Sorensen, health organizer for the Philadelphia Unemployment Project. “There has to be a more concerted effort
to deal with health care.”
http://www.philly.com/mld/philly/living/health/9684191.htm
Comment: Innumerable incremental measures, such as Pennsylvania’s adultBasic, have not been effective in even stabilizing the level of insurance coverage as the numbers of uninsured continue to increase. Other nations may struggle with queues for non-urgent services, but none of them condone queues for any health care coverage whatsoever. Our queues are criminally negligent, or at least they should be illegal.
As if the failure to adequately address the problem of increasing numbers of
uninsured were not enough, a Zogby poll last week revealed that 56% of Americans are now “personally affected” by health care costs. The 84% who do
have insurance now believe that health care costs are the number health care
concern. Middle America has been impacted.
Cost is an issue. Most current proposals for reform do not really address costs, in spite of the rhetoric, but rather only infuse more funds into our flawed system. The only approach currently under serious consideration that would work to reduce costs is to expand consumer-directed models of reform. The tragedy of this approach is that these models work by making essential health care services unaffordable, especially for those who have the greatest needs. That is the most inhumane policy approach that can be devised to contain costs.
There is tremendous waste in our system that is recoverable, but only if we adopt structural reforms that will improve our resource allocation. Prices in the United States are much higher than in other nations, pharmaceuticals being only one obvious example. Prices can be negotiated to ensure that only legitimate costs and fair profits are funded.
The well documented administrative excesses due to our fragmented system of
funding care are enormous and could be recovered by changing to a single
payer.
The tremendous technological excesses that are not beneficial, and sometimes
even detrimental, could be reduced by two measures. A strong primary care
base has been demonstrated to provide higher quality at lower cost. Providing incentives to strengthen the primary care base while reducing excessive rewards for high tech care would improve resource utilization. Excess capacity has also been demonstrated to increase the frequency and intensity of services without a commensurate benefit in health care outcomes. Planning and budgeting of capital improvements would reduce waste while ensuring adequate capacity to prevent excessive queues.
This is not rocket science. Through our tax system we’re already paying enough to fund the finest health care system in the world. But by international standards our health care delivery system is characterized by mediocrity, and affordable access to care is the worst of all industrialized nations. We are providing our government with the health care funds needed, but we are not demanding accountability for the use of those funds. We should hang our heads in shame.
Don McCanne
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