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Letters to the Editor
Restructure health care payment system
Editor:
I read with interest your column on community-managed health care. I am a health care economist, practicing out of Columbia. I applaud these community-based efforts, but until there is a restructuring of the payment/reimbursement incentives across the entire health care system, these efforts won’t be anything more than a band-aid.
The escape valve for our health care system is the rising number of the uninsured, most of whom work but their employers won’t or can’t afford employer-sponsored health insurance. Private insurance is unaffordable or, because of medical underwriting restrictions, unavailable.
Currently, half of all health care is paid for by public programs: Medicare, Medicaid, VA, etc. About 35% is paid for by either private or employer-provided health insurance. The remaining 15% of the population are uninsured. Almost half of all personal bankruptcies have major medical bills as a cause.
About half of uninsured South Carolinians have incomes of more than $50,000 and do not qualify for Medicaid or other low-income efforts. The average price for an individual health insurance policy can run from $375 to $500 a month, and family coverage ranges from $600 to $800 a month.
Health insurance alone can consume 25% or more of a middle class family’s income. It is comparable to what families spend on housing. This doesn’t include health care costs from deductibles, co-pays and non-covered medical services or for many prescription drugs.
The uninsured tend to avoid health
care. When they seek care, they are forced to seek care in hospital emergency departments. (Contrary to popular myth, it is not the uninsured who overuse hospital ERs but the insured using hospital ERs driving up emergency costs.) They are also much sicker when diagnosed, more costly to treat and ultimately die sooner than the insured.
Because of Medicare policy and regulations, hospitals have to accept, triage and treat a patient. Private physician offices don’t.
To see a private physician will often require a significant cash or credit card deposit, usually several hundred dollars. (Most physician offices don’t take personal checks from the uninsured.) Not many middle income families have an extra couple of hundred to cover this. So they go to the hospital ER.
Currently in America, it is your money or your life (or at least your house). So the community-managed health care efforts you describe are excellent, and there is value in the community pulling together to deal with health—focusing on being healthier and prevention are beneficial.
These are long-term efforts, and like not smoking, will have a pay-off in the distant future. However, the crisis is here and now.
Most South Carolinians are one major health event away from personal financial disaster. A major health event is not a catastrophic or traumatic condition but something as simple as a gall bladder attack or a broken leg or a mild heart attack—something with a price tag of between $35,000 and $50,000.
Even with health insurance, the typical South Carolinian can face $5,000 or more out of pocket expenses from this type of event.
The way we deal with this health care crisis reminds me of the passengers who continued dancing as the Titantic sank, . . . so please keep dancing.
Lynn Bailey
Health care economist
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