Friday, May 9, 2014

The Difference Between "Coverage" and "Care"

One of the biggest problems I've had with the debate over the Affordable Care Act from day one has been semantics.  First off, use of the term "Affordable" has applied to a select few when it comes to the purchase of health insurance.  And those "young and healthy" enrollees had to pay more for their policies to offset the influx of "old and sick" that insurers were required to cover.  In addition, the cost of care has continued to increase at a pace faster than inflation (although, not quite as fast as before the ACA).  The medical device tax has raised the prices on equipment both consumers and providers have had to pay--and has sent that industry overseas for cheaper labor costs. 

Plus, President Obama has repeatedly said that Americans are "guaranteed to get the care they need".  That is also not true--particularly for the 7-8 Million people who joined Medicaid programs in the states that were suckered into taking the short-term increase in Federal funding.  You see, a new study finds that fewer than half of doctors in specialty and advanced care practices actually see Medicaid patients.  And the minority of doctors that do accept Medicaid have substantially longer wait times for appointments and procedures.

Physicians who decline Medicaid do so for the very simple reason that the government program grossly underpays for the services provided.  Plus (as you might expect from a government program) the process of filing a claim for payment is onerous and Uncle Sam slow pays--meaning practices have to carry costs much longer than they should.  This underpayment is another of the shady accounting tricks contained in the Affordable Care Act to make it seem cheaper than the Trillion dollar price tag attributed to it. 

A cardiologist that performs heart surgery or a dermatologist that treats a skin condition can expect Medicaid reimbursement of just a fraction of the actual value of the service.  Supporters of the practice claim it "helps drive down the cost of health care".  But you don't see Uncle Sam "driving down the cost of military defense" by telling Boeing that it's only going to pay 2-million dollars for that 10-million dollar fighter jet--because the Pentagon knows that Boeing would not be building any more fighter jets.

So as we "celebrate" so many more people having health care "coverage", keep in mind that about half of them will find it very difficult to actually use it to get health "care".

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