“In America, we don’t leave people bleeding in the doorway of the emergency room.” I wrote that line for a presentation I used to give, some 25 years ago, about medical care in workers’ compensation.
There had been a time when some American hospitals did exactly that. Even in emergencies, patients had to produce an insurance card before they would be treated. A federal law was enacted in 1986 prohibiting hospitals from turning away patients in emergencies.
The system has been been battling ever since over who pays. The hospital? The taxpayers? The patient with no money? The Affordable Care Act offers one solution by requiring everybody to be insured and providing subsidies.
The “individual mandate” is one thing many Americans detest about the ACA. So, among the features of the new proposed healthcare law it took Congressional Republicans only six years to draft, the individual mandate is to be repealed. Young healthy people who think they don’t need insurance won’t have to buy it.
But young healthy people can get sick or injured. What does the proposed law anticipate when a young healthy uninsured person shows up with broken bones from a motorcycle accident? Who will pay the bill? Or will we go back to letting him bleed? That has to be one of our questions.
We’re going to have to ask many such questions, especially questions important to New Mexico. Such as how financially struggling New Mexico is supposed to continue paying Medicaid costs if the federal match is cut in 2020.
One urgent question is how many more reductions New Mexico doctors will tolerate before they all leave.
There aren’t enough doctors nationally because the federal government limits how many residents it will pay to train (see triplespacedagain.com, March 2014). Medicare sets different fee schedules for states based on a cost-of-living formula, with New Mexico at the lower end. So we are always competing with other states for health care professionals and coming up short.
A new buzzword we hear is “access to health care,” which is supposed to refer to the choice of insurance plans, but access to insurance is meaningless if there are not enough providers.
The ACA attempts to ensure that payment to providers will be adequate by capping insurance company profits, requiring that 80 percent of premiums be spent on medical costs. If a new law eliminates that rule, insurance companies will be free to become the next generation of payday lenders, charging whatever premiums they like and saving money by cutting payments to providers. As I have previously written, as long as insurance company profits are built in, the only way to reduce the cost of health care is to reduce the service provided.
The closest thing to a magical fix would be getting New Mexicans to adopt healthier habits, which might cut down our explosive rates of diabetes and other chronic conditions, but I won’t waste your time pretending that’s realistic.
Pontificating about personal responsibility won’t change the fate of New Mexico’s small towns, where access to health services is already tenuous. The simple stark reality is that contemporary health care is a complex and highly technical business that costs more than most people can afford, and we do not have national consensus on how to solve that problem. Proponents of the new bill say it will promote “competition,” but what specifically will competition achieve in the delivery of health care? It’s either a pipe dream or a reduction in services.
Mark Lautman, economic consultant to the state’s Job Council, has warned New Mexico is facing an “economic death spiral” if we don’t turn our economy around. If we lose access to health care throughout the state, we could be speeding up that death spiral, not just for individuals but for whole communities.
Triple Spaced Again, © New Mexico News Services 2017