- Prompt access to and attention from a qualified physician when medical care is needed
- Regular access to health care providers for consultation, advice, and preventive measures
- "Health Care" insurance
I thought of the survey after reading this statement from the New York Times:
WASHINGTON — Enrollment in Medicaid is surging as a result of the Affordable Care Act, but the Obama administration and state officials have done little to ensure that new beneficiaries have access to doctors after they get their Medicaid cards, federal investigators say in a new report. The report, to be issued this week by the inspector general at the Department of Health and Human Services, says state standards for access to care vary widely and are rarely enforced. As a result, it says, Medicaid patients often find that they must wait for months or travel long distances to see a doctor.It may be worth thinking about how in the world the Obama administration or state officials can "ensure... access to doctors" or how a state can have and enforce "a standard for access to care." Mandatory overtime for physicians perhaps? Or a bonus system to entice them to work longer hours?
The above clipping is just one in a string of several that seem to signal the future of actual US medical care (No. 1 in the survey above), an important subject lost in the shuffle of efforts trying to get everybody insured. I'm not making personal complaints here but just trying to understand the lay of the land and make some plans. Good health is primarily a function of genes and strategy, and it is only strategy over which we have any control.
A personal story, not a complaint, has to do with my interest in finally, after eight years of living in town, trying to find a GP or Family Practice physician within walking distance of our once new residence. That was always my plan, but I'm still driving out into the country to see my perfectly fine doctor of fifteen years. Cursory investigation of possibilities quickly revealed that many doctors with established practices don't take new Medicare patients. Of course most multi-physician practices take new Medicare patients but only to be assigned to the newer physicians still paying off their medical school debts. And, a physician friend tells me that it is common for doctors to limit their service to government insured patients to a certain percentage of their practice because of the low reimbursement rates. The bottom line is that low priced medical services demanded by government reimbursement programs already have limited availability, and the situation is unlikely to get better.
Consistent with that, we seem to have been facing a constant stream of news reports about how some health care expert or association has determined that some common preventive or diagnostic test is actually causing more problems that it has solved, resulting in a lot of stress-inducing and expense-incurring false positives and unnecessary treatments while saving only a very few lives. Chest X-Rays, which I got annually as a young person, seem to have become scarce, and now the annual PSA and Mammogram are being questioned, even as the recommended frequency for colonoscopies has decreased from one every seven to one every ten years.
And then there was Dr. Ezekiel Emanuel's Atlantic Magazine article, "Why I Hope to Die at 75." Dr. Emanuel is champion, defender, and a primary architect, of The Affordable Care Act. He has eighteen years to go before reaching 75 while I have only three, so his "hope" probably seems more reasonable to him than to me. Of course his title is somewhat hyperbolic to draw attention. He is not planning euthanasia and promises nothing more than to refuse to seek out life extending medical care, including the annual PSA check, once he reaches 75. I am betting he will break that promise and will have the influence and resources to do so.
Dr. Emanuel is well aware that the increase in demand for medical services by an aging population hoping to live to 100 is on a collision course with downward pressures on both Medicare reimbursements and physician availability, and that increased rationing is the future of medical services for the elderly. I suspect that Soylent Green may be one of his favorite movies.
Third, there was a story in the local news about a heart surgery unit in a local hospital being shut down because of lack of an approved Certificate of Need. Medical care is not a free and competitive market like cell phones and automobiles. Can you imagine Apple having to get a Certificate of Need before rolling out the next iPhone? Still, it is unclear to me why any hospital would want to invest in a service unless there were adequate demand to keep it busy. The combination of fewer facilities and lower reimbursement rates pretty much guarantees fewer surgeons and fewer operations along with higher profits for and longer waits at established facilities. It sounds like a death cycle, no pun intended. Medical care is a market, purchases being made, services being provided, bills being paid, and government planning of a market does not seem to me to be reasonable or likely to work very well. And I have little confidence that the decisions made and policies established are free of political and personal economic considerations and lobbyist influence.
And finally was Brett Baier's autobiographical account of his son's struggles with a heart defect requiring infant surgery, Special Heart: A Journey of Faith, Hope, Courage, and Love. It is good reading about a wonderful family, with a happy ending, and I recommend it, as well as his nightly news program, Special Report. The first big decision the family had to face was whether to endure a risky wait of a few weeks for a renowned pediatric heart surgeon, recommended by everyone but on a trip out of the country, or proceed with an available surgeon. They waited, and one thing we all know, reinforced by the Baier story, is that not all doctors and surgeons are equal. Thankfully, the Baier family, young and vigorous with bright futures and with many influential friends and family and the backing and support of the entire Fox News organization had access to excellent advice and unlimited resources. Most of us, certainly not the low income elderly person with only Medicare, are not going to get that kind of support or priority. Just think of the recent VA scandal. We all, fortunately, do have access to the prayer support on which the Baier family depended and to which they give credit for their son's progress.
What's the point? It is just that there are several indicators that medical care for the elderly, especially expensive and difficult elective surgeries and heroic life extending surgeries are likely to be increasingly scarce over the next few decades. Some of us will have our health improved and lives extended, of course, by government paid health care, and that will be enough for some people to say it is a good thing, same as non-critical assessments of Head Start, but the best hope for most of us is to need less of it. The first fifty years of Medicare have been a great and generous gift from the young to the old. Now we are going to have to "give back." (Unfortunately, some of those who will have to give back are the same ones who gave forward.) We need a plan.
So, as we age, let's get some healthy aerobic and stretching exercise every day, eat healthy foods in moderation, get rid of the gut and flab, say our prayers, get a good night's sleep, and have a glass of wine with dinner and an aspirin with breakfast every day. And focusing our attention on helping somebody every day, will help keep our minds off our own problems. Worry and stress, after all, can lead to illness.
Oh, and I almost forgot to mention this: Let's go to our local Red Cross and donate a pint of blood every eight weeks. It helps lower the levels of any bad stuff that might be building up in a closed system and might save the life of some young person undergoing expensive and difficult surgery. I recommend this in spite of the recent news item reporting that blood from young folks is better than blood from old folks.
We just have to do the best we can, making appropriate sacrifices, because somebody has determined that the USA spends too much on "health care," and we have to cut somewhere. At least we will all have insurance.