Legislators Need to Prevent Denial of Access to Healthcare

I've written a lot here on Substack about the destruction of the patient-doctor relationship by healthcare conglomerates and the denial of access to needed healthcare by insurance companies.

So I enjoyed recently reading a Commonwealth Fund article on the failing U.S healthcare system. The report compares healthcare system performance in ten nations. According to this article, 70 health system performance measures in five areas were analyzed, including access to care, care process, administrative efficiency, equity, and health outcomes. The conclusion was that the U.S. continues to be in a class by itself in underperformance of healthcare. All other countries studied had found ways to meet the most basic healthcare needs or residents, including access to medical care.

The other countries studied besides the U.S. included Australia, Canada, France, Germany, Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom.

It should be noted that the U.S. is the only developed nation without a national healthcare service. The vested interest in healthcare profits keep denigrating national healthcare services, claiming they are "socialistic" or that these national healthcare programs don't replace knees when patients want them replaced. That is, without the profit motive, there is no reason to replace knees that don't need to be replaced or provide all kinds of other expensive procedures that aren't needed. The cesarean section rate in the United States is 34 percent. In a profit-driven system such as the U.S. one, this high C-section rate shouldn't be surprising. Physicians are paid twice as much for a C-section than for a natural delivery. C-sections take much less time than natural deliveries. Never mind that C-sections are major surgeries with a higher risk of complications than vaginal births. In the U.S. healthcare system, follow the money.

I happen to have run across a list of the 14 Federal bipartisan healthcare bills which have passed. I've included brief summaries below of the contents of these 14 bills. There's nothing in these laws which address the real problem with the U.S. performance in healthcare: patient access. Elizabeth Rosenthal in An American Sickness tells us that the only way to fix the U.S. problems with healthcare is for the public to demand change from their congressional representatives. Take a look at the contents of these 14 bills summarized below and ask yourself if it's not time to contact your senators and representatives:

1. H.R. 8111 Requires "States to regularly obtain beneficiary address information from reliable sources…to promote the State’s ability to contact the beneficiary, and to confirm a Medicaid beneficiary’s residence is within the state."

2. H.R. 8112 Requires "States to regularly "check…provider’s enrollment…in the Medicaid program that the provider is not prohibited from participating in the Medicare program."

3. H.R. 8089 Requires states to check quarterly "in order to identify deceased providers."

4. H.R. 8084 Requires "States to screen [Medicare enrollees] to identify currently enrolled Medicaid beneficiaries who are deceased and remove identified deceased beneficiaries from enrollment in Medicaid."

5. H.R. 6160 Reauthorizes "the lifespan respite care program…to support state respite care systems. 

6. S. 4351 "Reauthorizes certain poison control programs."

7. H.R. 7406 Authorizes "NIH…to promote the scientific understanding of Down syndrome and co-occurring conditions and improve the quality of life of every American, not just individuals with Down syndrome and their families. 

8. H.R. 7218 Reauthorizes "programs to support efforts to educate and support …awareness of Alzheimer's disease and related dementias…."

9. H.R. 6033 Requires "the Secretary of Health and Human Services to…issue and disseminate best practices for delivering quality care via telehealth to beneficiaries with limited English language."

10. H.R. 7858 Improves "process by which Medicare tracks claims for services provided by telehealth."

11. S. 265 Reauthorizes "the rural emergency medical services (EMS) training program…."

12. H.R. 7208 Reauthorizes the "Traumatic Brain Injury (TBI) programs…which allocate resources for TBI prevention, improving access to TBI rehabilitation, and support TBI patient advocacy systems."

13. H.R. 4758  Streamlines "Medicaid and Children’s Health Insurance Program (CHIP) out-of-state pediatric provider enrollment requirements to promote timely access to care for children needing to travel out-of-state for care."

14. H.R. 7213 Reauthorizes "certain programs related to autism spectrum disorder…." 

These laws are largely aimed at being sure anyone enrolled in a Medicaid or Medicare program, whether patient or provider, is actually alive and lives in the state listed in our healthcare system. Most of these 14 laws simply reauthorize already existing laws. Also note that there's nothing new here.  One law "streamlines" trying to get make it quicker for children on Medicaid or in the CHIPS program who need out-of-state care to actually get the care needed, but why limit this to children? I've had a patient with repeated strokes forced to wait six months for out-of-state care. 

Thirty years ago I wrote Modern Medicine: What You're Dying to Know because even back then, it was clear what was happening to patient access to healthcare in this country. There are five chapters in the book, chapters dealing with the growing inability of patients to access the healthcare they need as physician decisions about patient care were taken over by corporate medicine, insurances, and pharmaceutical companies. I, like Elizabeth Rosenthal, told readers to talk to their legislators about what was happening to health care in this country.

Clearly, denying patient access to healthcare doesn’t work. It just generates a lot of income for those owning the hospitals and clinics, insurance companies, and pharmaceutical companies.

What the U.S. does better than any other country is to spend loads of money denying access. That’s why we have the most expensive healthcare on earth coupled with the worst performance of any developed country in providing care. Our life expectancy is 4 to 6 years less than the other countries in the Commonwealth study. Our C-section rate is among highest in developed countries. Our maternal mortality rate is higher than that in any developed country.

Americans today are 50% more likely to die in the period surrounding childbirth than their own mothers.

Dr. Neel Shah, MD, Assistant Professor of Obstetrics and Gynecology, Harvard Medical School

Thirty-five years ago when I wrote Modern Medicine, small rural hospitals and clinics were being gobbling up by larger metropolitan clinics and hospitals. The excuse was always that the larger entity would provide improved care and better efficiency. Some of these purchasers simply lied and claimed costs would come down. What was really going on then was that the metropolitan hospitals were buying up the smaller hospitals in rural areas to close them down, forcing everyone to travel to metropolitan areas for their healthcare. This included closing down the nursing homes to get the beds moved to their metropolitan hospital location. The public often remains unaware of the business of buying nursing home beds. States have a set number of nursing home beds so the best way to increase nursing home beds is to obtain control of existing nursing home beds. The rural healthcare desert is no mystery. The politicians in healthcare are in denial of the real cause of the U.S. dysfunctional healthcare system.

The job of the Department of Justice (DOJ) is consumer protection for the average consumer from organizations which plunder monopolies for profit . Right now, the best thing the DOJ could do is to halt any purchase of any healthcare entity for the next two decades. Congress should also rescind the law passed in 1996 which prevents physicians from owning hospitals. The reasoning was that physicians would overcharge for their services if they owned the hospitals. Of course, corporately owned non-profit hospitals aren't considered in any danger of overcharging patients.  Consumers need to ask where the money comes from when the big hospital buys a smaller one. Again, the average consumer foots that bill in the form of increasing insurance premiums, increasing deductibles, and increasing co-pays.

According to the Commonwealth Fund, leverage is a cause of rapidly increasing healthcare costs.

Massive consolidation through hospital mergers or hospital acquisitions of physician practices, among other examples, has enabled large providers to negotiate higher prices from private insurers — a key factor in the overall higher costs of care in the U.S….No other country relies to this extent on the unregulated private market to allocate vital health care resources.

Another huge problem is the proliferation of administrators with horrendous salaries. Some hospital CEOs make as much as $22 million a year. The lame excuse on the part of the hospital boards condoning these salaries is that everybody else is doing the same and our health care system need to be competitive.

The U.S. healthcare system currently is unable to provide the care the public not only needs, but also the kind of care which every other developed country offers its citizens. Until physicians are once again able to make medical decisions for their patients instead of corporate medicine, insurances, and pharmaceutical companies, the U.S. will continue to have a dysfunctional healthcare system based on profits for owners of corporations rather than the provisions of patient access to needed care.

Time to contact your congressional representatives.

Note: Illustration by Trygve Olson who illustrated Modern Medicine.