ER not a substitute for primary care: Medicare for All is the solution

Jack Bernard is a retired SVP with a national firm. He is also the former Chair of the Jasper County Commission and Republican Party.

Note: Jack Bernard’s family has used the ER services at Piedmont-Fayette Hospital twice in the last year. Care and staff were excellent. However, the ER itself was impacted, overcrowded (some patients in the waiting room were standing) and the staff was clearly over worked. Obviously, a number of the people waiting were indigent and in need of primary care versus emergency care, increasing the cost of healthcare for the rest of us via rising healthcare premiums.

 

Some politicians, and even some physicians like our former DHHS Secretary Tom Price, will say that all US citizens can get high quality healthcare right now if they truly need it.  They say the big problem is just premiums going up due to Obamacare and that all will be well if we just go to a real free market system, as they proposed with the now failed effort at Trumpcare.
They say adequate care can always be found in the ER for those not able to purchase insurance. But ER visits by the uninsured are no substitute for affordable primary care.
Dr. Davis Dvorak is a practicing ER physician in Minnesota, a state with above average providers, and he has detailed specific cases below. Similar instances of systemic failure are found everywhere in our nation, including right here in Georgia:
Case 1: A middle-aged woman presented to the ED with life-threatening swelling of her throat from a severe allergic reaction. The emergency physician placed a breathing tube to save her life. Thereafter, she spent several days on a respirator in the ICU.
This entire costly episode (indirectly passed on to paying patients) could have been prevented if she been financially able to fill her prescription for an Epi-Pen, a medication previously prescribed for her recurrent allergic reactions. Why hadn’t she already filled it? On a severely limited income and without insurance, she could not afford the medication, which now costs $600 after recent price gouging by the maker.
Case 2: A young man came to the hospital emergency department (ED) with a severe arm infection. Over the prior week, he had developed an abscess (a collection of infected fluid) in his forearm. Because he was uninsured and couldn’t afford primary care, he attempted to drain the abscess at home by puncturing it with a sewing needle. The infection only worsened…it spread up his arm and he developed high fever. He required emergency drainage of the abscess, followed by costly inpatient hospitalization and IV antibiotics. This expense was picked up by the hospital, which once again indirectly passed the cost on to paying patients.
In the wealthiest nation in the history of the world, there is currently great human suffering that could, and must from a moral standpoint, be alleviated. Plus, because treatments are delayed until conditions significantly deteriorate the overall expense to the health care system is enormous.
The overall situation is getting worse financially for our nation as well. In 1980, 9 percent of our GNP went towards healthcare. It is double that now (Gallup, 12-16).
What can be done to improve the situation? The President and Congress have said that they want to repeal and replace the ACA (Obamacare). Objectively, the ACA continues to be problematic with just over half of Americans supporting it, but virtually no one agrees with Trumpcare.
The ACA has expanded coverage to over 20 million citizens in need, but, as the above cases illustrate, the current system is not working for the nearly 30 million Americans still without insurance coverage
The Supreme Court decision making Medicaid expansion voluntary by states has left 19 states without any expansion at all. Georgia, one of the 19, now has the third highest rate of uninsured nationally. Premiums and deductibles for many Healthcare Exchange enrollees are rising substantially while insurers are leaving the market, creating monopolies in some areas.
The answer is clearly not what  former Sec. Price and Speaker Ryan advocate: abolishment of the ACA and enactment of unproven ideological, right wing, private enterprise policies. Limited initiatives, such as small stipends based on income and selling insurance across state lines, simply will not get 50 million uninsured Americans covered. Retaining mandates such as restrictions against refusing coverage based on pre-existing conditions will only cause costs to escalate.
Furthermore, the Price-Ryan approach to privatizing traditional Medicare will shift costs to our vulnerable seniors. That will reduce access, not increase it.
If the questionable Price/Ryan approach, already rejected by Congress despite pleas by a President desperate for a political win, is not the answer, what can be done to help our citizens get affordable healthcare insurance? The bottom line is that the only cost effective way to make sure that needed care is given to those who require it is to expand our popular traditional Medicare program, which has admin expenses of 3 percent versus up to 20 percent for private insurers.
Dr. Gerald Friedman of the University of Mass.-Amherst has studied the issue and found that there would be a savings of $592 billion annually under Medicare for All.
Expanding Medicare to cover everyone can be paid for via payroll tax, much the same as Social Security is funded now, plus closing tax loop holes and ending corporate welfare (for example, tax subsidies for international farming corporations and energy companies). Details regarding the efficacy of single payer and how it can be financed can be found at the web site of Physicians for a National Health Program at www.pnhp.org.
On the political level, is there a light at the end of the tunnel? Yes, some members of Congress do understand the situation, with the majority of House Democrats supporting HB 676, Medicare for all. The recent national campaign of Bernie Sanders brought the issue to center stage and he introduced a similar bill in the Senate sponsored by 15 Democrats.
Even Trump stated that in an ideal world, the Canadian system is optimal. Then, why not propose expansion of Medicare?
The real impediment is the lobbyists for insurance and big pharma who control our Congress. This deplorable situation can only be changed through pressure by you, the voters of America.

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