Excellent summary of a recent talk given by Princeton’s Uwe Reinhardt. One interesting point the post brings up is health care for the poor, and how this is a legacy of racism:
The way we pay health care providers who take Medicaid patients illustrates just how conflicted we are. Doctors who treat these patients are paid much less then they would be if they were treading Medicare patients . . .. . . Southern Congressmen refused to vote for the 1965 legislation that created both Medicare and Medicaid if physicians and hospitals were going to be paid as much to treat the poor as they were paid when treating the elderly. These Congressmen wanted to preserve medical apartheid (most Southerners over the age of 65 were white: a combination of poverty and a lack of healthcare ensured that few African-Americans lived that long).
Ultimately President Johnson had no choice but to cave to the legislators’ demands. What is both shameful and startling is that forty-three years later, this wrong still has not been righted.
As stated here before, the fundamental question of whether health care is a right needs to be answered before any type of major reform can hope to succeed.
Maybe, like Taiwan, this needs to be addressed by the Supreme Court.
Related posts:
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- Is President Obama trying to do too much with health reform?
- "Maternity care is a money loser for most hospitals, and there is no break-even point"
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- CBO cost analysis of the Baucus health reform plan
{ 8 comments }
Very simple scenario:
Does an unemployed, uninsured patient who walks into an ER with appendicitis have a right to have that condition treated?
I do not like sloganeering either; but we cannot have a society where those requiring acute, urgent care are turned away because of an inability to pay.
So, therefore, my answer is yes, healthcare is a right.
A family practitioner
Family practitioner, since healthcare is a right, are you okay with being forced to provide your services to that unemployed/uninsured patient for free?
Does a homeless person have a right to walk into your two story home in the middle of winter during a driving blizzard and claim your spare bedroom as their place of residence, or risk freezing to death?
Does this same unemployed homeless person have the right to claim ownership to your closet full of cloths and shoes so he keeps from freezing to death out in the cold?
Does this same unemployed homeless person have the right to claim ownership of all your food in the pantry when he has not eaten in 3 weeks and risks death by starvation?
Is your room, food and cloths a right for others to claim ownership of? Answer that question and you answer the right to force health care providers to treat patients for free.
If the government wishes to mandate hospitals and providers to provide care to those unable to pay for it, then the government needs to adequately pay for those mandated services.
When you fail to do so, you get the current result. Doctors of all specialties fleeing the free care haven of ER medicine into their secluded offices and invitation only specialty hospitals.
Anonymous (FP) at 10:59 wrote:
“Very simple scenario:
Does an unemployed, uninsured patient who walks into an ER with appendicitis have a right to have that condition treated? . . .
So, therefore, my answer is yes, healthcare is a right.”
Evidence on the ground suggests you may be correct, by virtue of EMTALA and its subsidiary powers to compel uncompensated medical staff at receiving hospitals and staff of other hospitals compelled to receive patients on transfer.
The federal government has, by its legislation and regulation, created a right of taking by citizens the labor and property of other citizens without their consent and without recourse for non-payment, save civil actions.
If the taking patient is without resources, the doctor is out of luck.
It is a fact on the ground.
But is it right? Some think it is OK, as long as they aren’t made to pay for it, so don’t ask them to pay an extra income tax to support this transfer of goods and services. Medicare doesn’t provide supplemental payment for uncompensated or emergency services either. Worse, Medicare prohibits above-schedule billing by those doctors whose practices are burdened by large amounts of uncompensated care. In fact, it harshly punishes practices inclined to make patients pay what it costs that practice to provide care. So how does a practice limit its exposure to loss? As a responsible business, it has to consider this, no matter how sympathetic the practitioners may be to the plight of the sick and underfunded. One way is to stop covering emergency rooms. Another is to stop seeing inpatients. Still another is to close the practice to third-party payment organizations that deliver underpaying patients to the practice, like Medicaid and increasingly, Medicare.
Effectively, health care by expropriation has become a “right”.
I am wondering when shoplifting becomes a right, too.
The question of whether healthcare is a right is not synonymous with whether physicians should be forced to provide free services.
I pay taxes for a lot of things that annoy me, such as pork barrel projects and corporate welfare. My tax dollars are bailing out greedy investors and corporations who put this country’s economic health in jeopardy due to lack of regulation. I pay taxes for welfare and unemployment compensation that requires excessive funding because American jobs are now in the hands of developing nations.
And so do you.
Don’t you think that’s contributed to the healthcare funding crisis we experience now? Don’t you think our government budgetary priorities have gotten a little out whack? Or do you believe this nation should solely operate for the benefit of the minority elite?
Personally, I’d much rather pay taxes that provide for the well-being of my fellow citizen, many of whom are, were, or will also be tax payers, than squander it on corporate welfare.
Too many of you are personalizing the issue and not looking beyond the end of your collective noses. This is a moral and ethical problem that needs to be addressed in a humanitarian fashion.
Yes, the current system is broken. It needs to be fixed in a way that benefits both physicians and patients, rather than pitting them against each other as adversaries.
It’s hard to be charitable towards Reinhardt, whose pronoucements about medical economics have been reliably wrong ever since the Carter administration.
I would love to know the accuracy and documentation for your opening comment: “Southern Congressmen refused to vote for the 1965 legislation that created both Medicare and Medicaid if physicians and hospitals were going to be paid as much to treat the poor as they were paid when treating the elderly. These Congressmen wanted to preserve medical apartheid (most Southerners over the age of 65 were white”. It strikes me as a bit polemic in nature as well . There were and still are a large percentage of poor whites in the south, and I suspect a number of blacks who were over age 65
Wouldn’t you like to know where Uwe gets his facts about the motives of the southern congressmen. As one who grew up in the south in the 1960’s there were a lots of very poor whites in the south. I am sure there were also a substantial number of African Americans over 65 at that time as well.
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