January 18, 2010

Would you take a Medicaid card or health care?

Dr. Mayer-Hermann by Otto Dix

By Mark M. Ryan

Will expanding the number of Americans insured by government sponsored health plans mean that more Americans will have access to quality and affordable health care? Not if doctors, hospitals, and pharmacies decide not to accept the government insurance.

~ January 19, 2010


The Congress’s and President’s heath care reform plan promoted in the media is not surprisingly very simple.  We can give more Americans access to health care by expanding enrollment in government sponsored, or even government managed, insurance plans.  But there is an important point here that has been missed in the public debate: expanding the number of Americans insured by government sponsored health plans does not mean that more Americans will have access to quality and affordable health care.  In short, what good is a health insurance card if no one accepts it?

Here is a telling article from the Wall Street Journal’s Health Blog reporting on Walgreens’s threat to stop filling Medicaid prescriptions due to below market-rate reimbursements from the government.  Walgreens would join a substantial number of health care providers across the United States who do not accept Medicaid patients in their practices due to the government’s below-market rates of reimbursement.

As a physician, I have an inherent interest in seeing health care providers’ reimbursements increase.  As a tax-payer, I have an interest in ensuring that government monies are used efficiently and effectively.  Giving 50 million more Americans government sponsored health insurance that health care providers and pharmacies will not accept is not, in my opinion, and effective use of government resources.  It is not effective because it will not solve the underlying problem: health care in America appears to be too expensive for the majority of individual Americans.

I say “appears” to be too expensive because the truth is that the public does not knows how much health care actually costs.  The only widely publicized prices in health care are for elective cosmetic procedures.  And when it comes to primary care, most providers are as clueless as their patients when asked the price of an office visit.  Any other professional has a price list for the services they provide.  Medicine, however, has ceded the responsibility of setting prices to the private and public insurance companies.  If you ask any patient how much an office visit costs, they will tell you the amount of their co-pay, their perceived cost.  Ask any provider how much they charge for an office visit, and they will tell you an inflated price quoted to insurance companies with the knowledge that the insurance company will pay only a fraction of the quote.  The problem is that there is limited structure and even less transparency in health care, which creates wide fluctuations in price and opportunities for price gauging.  Government’s legitimate role is to structure markets and create and enforce transparency in market transactions.

Imagine physicians were obliged to divulge the price of office visits, diabetes treatment, annual physicals, etc. to their patients.  Patients would be able to compare competing providers’ prices and make a rational decision about how to spend their resources.  Patient’s could then make informed decisions about what, if any, insurance they needed to purchase in order to access health care.

~ www.markmryan.com                                                                                          January 19, 2010


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