Clark's Scribbles

National Health Care

A National Health Care Plan must be a top priority. Now. The Coronavirus Pandemic of 2020 has highlighted our weaknesses. The patient deluge overwhelmed our resources. We were slow in addressing shortages. Those shortages began with facilities and trained personnel and went on to include vital equipment and supplies. Our inability to supply our “front line” workers with PPE was criminal.

The great debate over Medicare-For-All versus improvements to the ACA missed the 900-pound gorilla in the room. Health Insurance is not Health Care. Insurance alone cannot solve our problems. National policies are needed to ensure that healthcare resources are available in places that are not economically attractive. Policies are required to ensure that general practitioners as well as medical specialists, are available as needed. Telemedicine can help. AI and smart devices may relieve some of the pressure but not without regulation. 

Shortly after I retired, chewing gum pulled the crown off a molar. I was able to push it back in place, but it kept coming loose when I ate. I needed to see a dentist. My Medicare Advantage Plan included a dental plan, but the coverage was provided by an outside company. It took several days to get an appointment with a dentist who accepted that plan.

I had insurance. Getting health care was another matter. Every insured American faces this dilemma at times.

Demand for health care grows as our population grows and ages. Today’s 325 million population needs more doctors and hospitals than a population of 200 million (1967 – 50 years ago). We expect to add another 25 million over the next decade. That means more doctors and hospitals.

Older people, for example, those in their eighties, need more health care than people in their prime. Approximately 7 million Americans are eighty-five or older. That is up from 4 million at the turn of the century. Another 47 million of us are between sixty-five and eighty-five. We also need more health care than their children and grandchildren.

My medical issues have increased as I have aged. Many of the problems, high blood pressure, and Type II Diabetes, for example, are easily treated with medication. I take the pills prescribed by my primary care physician twice a day. When I’m running low, I call the pharmacy for a refill, which generally shows up in the mail the next day.

But I have needed four surgical procedures in the last ten years. Both hips were replaced in 2012. I had a cataract replacement surgery in 2018 and a hernia repair in 2019. None of those operations were performed at the hospital a few blocks from my house. Prince George’s Community Hospital, where my second daughter was born and where my first wife died, fell on hard times. A few years ago, it was taken over by the University of Maryland.

I believe I could have arranged for the surgeries to be performed at the hospital nearest my home since I am on Medicare. But I would have had to find a doctor to perform the operation. That doctor would have required me to get X-rays. An evaluation from “my” doctor would have been necessary. I found it easier to work through Kaiser Permanente, which manages my Medicare Advantage plan. 

Kaiser took care of the X-rays and set me up with an orthopedic surgeon. He performed his surgeries at a hospital in Bethesda, twenty-five miles from my house. I was left with the challenge of arranging transportation.

The cataract surgery was performed at a Kaiser medical center in Rockville, thirty miles from my house. My son-in-law generously took time off to make sure I got there and back.

The factors that determined my choices, the real issues for people needing health care, are not considered in statistical studies. These problems will continue to become more challenging as the demand for health care outpaces resource development.

We are not producing doctors fast enough to keep up with the demand. A shortage is coming. “… Americans [already] feel the shortfall … According to public opinion research conducted in 2019 by Public Opinion Strategies for the AAMC, 35% of voters said they had trouble finding a doctor in the past two or three years. That’s 10 points higher than when the question was asked in 2015.” (Patrick Boyle, Staff Writer June 26, 2020) 

In another decade, the physician shortage could exceed 100,000. Double that if we are to provide adequate health care to currently underserved populations.

Hospitals are closing. Financial challenges are forcing them to find rescuers or shut their doors. Johns Hopkins University has taken over some hospitals in the D.C. Metro area. The Prince George’s Community Hospital, which opened in 1944, struggled for decades. It was taken over by the University of Maryland Medical System in September 2017. It will be replaced by a new facility scheduled to open in 2021.

The venerable Providence Hospital, which had served Southeast D.C. for over 150 years, closed in April 2019. It reopened as Providence Health Services Care Center focusing on primary and community care services.

Rural hospitals are closing at an alarming rate – 120 have gone under in the last decade. One-third of those closings came in the last two years. An additional 450 are at risk. Yet we are going to need those hospitals and more to meet health care demands over the next decade.

This trend creates another set of health care issues. These facilities house the resources needed for emergency and specialized care. They cannot be adequately replaced by small medical centers or doctor’s offices, let alone home care. 

Many local residents use the Emergency Department of a nearby hospital as an alternative to the doctor’s office. This “non-optimal” use of emergency rooms grew by thirty million annual visits between 1996 and 2006. The many reasons for this situation boil down to The United States does not have a health care system. We have a patchwork of care providers, facilities, and insurance providers.

Doctors, nurses, counselors are in short supply. If you need one, you have to make an appointment. You will probably be put off for days or weeks unless you have a real emergency. When you show up for your scheduled appointment, you will be asked to wait until the doctor is ready to see you.

If you want to get into a hospital for a hip replacement, for example, you will have to meet with a doctor and schedule the operation at the convenience of the doctor and the hospital. Both the doctor and the hospital bed must be available for surgery to be performed. They will both bill your insurance provider. Payment will be due at the time service is provided. If you have insurance, doctors and hospitals will trust your provider to make the payment. Otherwise, it’s on you to fork over the dough or produce a credit card that can be charged.

The arrangement is not user friendly. You pay for insurance so you can afford health care. Health care providers collect from insurance companies like sugar daddies. The insurance companies flourish as long as there are no disasters to create unexpected demands on their resources.

Shortages are not uniformly distributed. The northeastern part of our country is well supplied with hospitals and care providers. The south and southwest are at the other end of the spectrum. Massachusetts has 450 physicians per 100,000 population. Mississippi has less than 200.

Most of the hospitals that closed and those at risk of closing are small, rural facilities. Universal health insurance, such as a reboot of the Affordable Care Act or Medicare-For-All, would boost demand in more impoverished areas and help keep the care facilities open. Enacting those measures will require the Democrats to gain control of both the Senate and the House and then hammer out the legislation. This process could take more than a year. Realizing the benefits will take even longer.

In the meantime, other health care issues must be addressed. Medical facilities must be provided. Those that are in operation must be supported. Those that are needed in poorly served regions must be built. Medical professionals to staff those facilities and provide other forms of service must be trained and nurtured. Medicare-For-All is probably a good idea. Health care for all should be our real goal.