Anatomy of the Health Care Crisis in the US
toto
What does a health crisis look like? See Houston
Here, the national statistic of 45 million uninsured people is more
than a number. It's a crisis.
Nationally, more than 15% are uninsured. In Texas it's nearly 24%, the
Census Bureau says, the highest percentage among the states. Here in
Harris County, it's 30%, according to state figures, the highest rate
among the nation's top 10 metropolitan areas.
As the Houston area struggles to deal with a rising tide of uninsured,
it offers a lesson for the nation: Let the problem get out of hand �
to a point where nearly 1 in 3 people have no coverage � and you won't
just have a less healthy population. You'll have an overwhelmed health
care system.
"Texas is the case study for system implosion," says neurosurgeon Guy
Clifton, founder of the Houston-area group Save Our ERs.
The problems here, as elsewhere, are many. Small employers are
dropping health coverage. Federal and state subsidies don't make up
the difference. Illegal immigrants represent 21% of the county's
public caseload, even though they represent only about 6% of the
area's population.
Compounding the problem, insurers are slashing hospitals'
reimbursement rates, often leading the hospitals to reduce
unprofitable services such as emergency rooms.
The huge number of uninsured residents here means that health
officials must make tough decisions every day about who gets treated
and when. "Does this mean rationing? You bet it does," says Kenneth
Mattox, chief of staff at Ben Taub, the Houston area's pre-eminent
trauma care facility.
Some states are trying to tackle the problem. The broadest solutions
have been advanced in Massachusetts, Vermont and Maine. California,
Illinois and Pennsylvania may not be far behind. Still more states are
trying to insure all children as a first step toward insuring all
residents. In most of those states, proposals range from increasing
government subsidies to mandating that either employers offer or
consumers buy coverage.
Then there's Texas, where the insurance crisis has multiple causes:
Small businesses dominate the economy, but only 31% of those with 50
or fewer employees offer insurance in Texas, compared with 43%
nationally. As a result, 48% of Texans are covered by employers,
compared with 53% nationally.
Income limits to qualify for Medicaid, the federal-state health
insurance program for the poor and disabled, are among the lowest in
the nation here. Texas has set a limit of $4,822 per year for a family
of three, compared with nearly $10,000 in Florida, $18,000 in
California and $25,000 in New York. Texas has no subsidized health
insurance program for childless adults; 19 states and the District of
Columbia offer some coverage.
The state has forfeited more than $900 million in federal money under
the Children's Health Insurance Program (CHIP) during the past six
years because it wouldn't put up 28 cents for each 72 cents in federal
aid. Restrictions put in place in 2003 cut about 200,000 children from
the program in a state with the highest percentage of uninsured
children, nearly twice the national average. "It's a horrible
scandal," says Jeffrey Starke, chief of pediatrics at Ben Taub.
State officials say the biggest problem in Texas is a surging
population: about 23.5 million in 2006, up 12.7% from 2000, about
twice the national growth rate. Texas' increase has continued to be
fueled by immigrants who cross the nation's longest border with
Mexico.
"We have tremendous population growth, and we have to try to keep up
with that," says Nora Belcher, senior health adviser to Gov. Rick
Perry.
The state's Medicaid program has doubled in cost in 10 years despite
its low income limits, Belcher says. CHIP money was left on the table
because the program started late and could not be fully funded during
a 2003 budget shortfall.
"Others would call us cheap," she says. "We think we're prudent."
'This system is broken'
The growth of the nation's uninsured population has stretched hospital
emergency departments to the breaking point.
Nationally, ER visits rose from 93 million to 110 million from 1994 to
2004, an 18% jump, according to the Centers for Disease Control and
Prevention. Texas experienced a 33% increase; in the Houston area, it
was more than 50%, according to the Texas Hospital Association. The
number of hospital emergency departments dropped by more than 12% in
the USA in the same period.
Emergency rooms here are routinely overcrowded. "When I came in this
morning, there were people waiting from yesterday," says Kellie
Manger, a triage nurse at Ben Taub, on a recent weekday.
About half of the people going to emergency rooms here just need
primary care, a percentage that's similar elsewhere. "We see lots of
patients here who haven't seen a doctor in years," says Katherine
King-Casas, an emergency room physician at Ben Taub.
Packed emergency rooms also are caused by overcrowded hospitals in
general. At Ben Taub, Mattox gets calls from area business leaders and
politicians seeking to "sneak in the back door a maid, a nanny."
Doctors, frustrated by long delays for surgeries, try getting patients
admitted to the hospital to move them ahead in line.
"Safety-net facilities were never designed to handle one-third of a
population," says George Masi, Ben Taub's chief operating officer. "I
don't think this is unique to Texas. Something's got to be done. This
system is broken."
Crowding leads hospitals to send patients elsewhere.
In the Houston area, hospitals divert patients about 20% of the time,
says Charles Begley of the University of Texas School of Public
Health. Ambulances pile up outside emergency rooms, often waiting an
hour or two to get their patients in for treatment. David Persse, the
Houston Fire Department's medical director, says the area record is
six hours. The situation is so bad that patients have called 911 from
one ER to get to another.
Doctors here cite horror stories, such as the patient who died after
being diverted by helicopter from a Houston hospital to one in Austin.
"Diversion kills you," Clifton says.
--
Dorothy
There is no sound, no cry in all the world
that can be heard unless someone listens ..
The Outer Limits
dot mail dot to dot mo@gmail.com Mo
will never get how any civilised nation can have so many uninsured people...
I won't say the Dutch system is perfect (far from it!), but at least
everybody has medical insurance. Of course there are those who don't pay
their premiums, but as one below the poverty line I can assure you that
that's a choice. AFAIK everyone will get helped, even if they haven't paid
their premiums. They'll get the same level of care as well.
--
Mo
superbitch
like mo, i'm not american but was quite shocked by when i saw sicko...
i live in the uk, and whilst we moan about it, we are incredibly lucky
to have the national health service, although it is ailing somewhat
under its current incarnation. the rise of alcohol problems in
particular threatens to swamp it, and this is an areas that i think
needs to be addressed as a prevention rather than cure strategy,
certainly within the uk.
but i digress. i saw on the news that barack obama's healthcare bill
was passed a few weeks ago, (i think?!) but obviously it takes time
for change to filter down from the top to the end user. what that
article says to me is that the current system is at breaking point, if
not beyond, and it must be an incredibly scary situation for those
huge numbers of people who are not insured.
will not get started on a rant about multinational corporations...
take it easy
helne x
toto
The fact is that the healthcare bill did NOT pass yet. What happened
is that the Senate approved one bill and the House approved a
different bill and the two have to be reconciled into a single bill
before it becomes law.
There are a few good things in it and much that gives private
insurance companies a windfall.
Key provisions that are good include - coverage of pre-existing
conditions, premiums that are not discrimatory based on gender, age or
health status and not allowing companies to rescind coverage due to
typos, etc when the person becomes sick (believe it or not, insurance
companies have done this to lots of people).
While both bills require everyone have health insurance, how they get
it is different.
Abortion coverage is a sticking point - there is no telling what will
happen with that.
dot mail dot to dot mo@gmail.com Mo
> <snip atrocious situation>
>
> like mo, i'm not american but was quite shocked by when i saw sicko...
Unfortunately I still haven't seen that movie, I'm waiting for one of the
Dutch networks to air it (which I expect to be some time this year).
> i live in the uk, and whilst we moan about it, we are incredibly lucky
> to have the national health service, although it is ailing somewhat
> under its current incarnation. the rise of alcohol problems in
> particular threatens to swamp it, and this is an areas that i think
> needs to be addressed as a prevention rather than cure strategy,
> certainly within the uk.
Definitely. And what I have read about the NHS this completely inconsistent
policy of paying for a certain medication in one region and not in another
needs to be addressed shortly, as well as the whole administrative problem
with getting treatment outside your own NHS region. I read the BBC News
newsletter every day and at the end of last year I read a story about a lady
who had had her urgently needed eye surgery postponed indefinitely because
her NHS region didn't have a contract with the surgeon or the hospital,
something like that. Absolutely unacceptable.
Same thing happening here in the Netherlands BTW, we have so many health
insurers now that none has contracts with /all/ individual caregivers, so
that you might very well have to pay the bill yourself first and then can
try to reclaim the money from your insurer. Ridiculous. There's also this
stupid and expensive system where the lower incomes get a monthly
compensation for the health insurance premium. Rather than inventing this
system that is costing hundreds of millions a year, they should have just
made the premiums dependant on income. That way the higher incomes would pay
more, which would fund increasing costs of the whole system. Problem solved.
> but i digress. i saw on the news that barack obama's healthcare bill
> was passed a few weeks ago, (i think?!) but obviously it takes time
> for change to filter down from the top to the end user. what that
> article says to me is that the current system is at breaking point, if
> not beyond, and it must be an incredibly scary situation for those
> huge numbers of people who are not insured.
Or for those with limited insurance. I'll never get that you can be insured
for a certain illness (say cancer treatment) and then see your treatment
stopped after a certain time, because apparently you have maxed out on what
they will pay for. As bad as the Dutch system may be, I don't see that
happening here.
> will not get started on a rant about multinational corporations...
OK, neither will I then LOL.
--
Mo
dot mail dot to dot mo@gmail.com Mo
> On Sun, 3 Jan 2010 18:32:18 -0800 (PST), superbitch
> <super...@ukonline.co.uk> wrote:
>
>> <snip atrocious situation>
>>
>> like mo, i'm not american but was quite shocked by when i saw
>> sicko... i live in the uk, and whilst we moan about it, we are
>> incredibly lucky to have the national health service, although it is
>> ailing somewhat under its current incarnation. the rise of alcohol
>> problems in particular threatens to swamp it, and this is an areas
>> that i think needs to be addressed as a prevention rather than cure
>> strategy, certainly within the uk.
>>
>> but i digress. i saw on the news that barack obama's healthcare bill
>> was passed a few weeks ago, (i think?!) but obviously it takes time
>> for change to filter down from the top to the end user. what that
>> article says to me is that the current system is at breaking point,
>> if not beyond, and it must be an incredibly scary situation for those
>> huge numbers of people who are not insured.
>>
>> will not get started on a rant about multinational corporations...
>>
>> take it easy
>> helne x
>
> The fact is that the healthcare bill did NOT pass yet. What happened
> is that the Senate approved one bill and the House approved a
> different bill and the two have to be reconciled into a single bill
> before it becomes law.
Yes, I've heard about that, it's not going to be easy at all.
> There are a few good things in it and much that gives private
> insurance companies a windfall.
And health insurance should never be about profits and such :-(.
> Key provisions that are good include - coverage of pre-existing
> conditions, premiums that are not discrimatory based on gender, age or
> health status and not allowing companies to rescind coverage due to
> typos, etc when the person becomes sick (believe it or not, insurance
> companies have done this to lots of people).
I know :-(. They're trying to do that now here as well. The Dutch system has
a basic coverage which is government controlled and the same for all
insurance companies (though premiums vary widely). Additional insurances,
their contents/coverage and their terms are completely up to the insurance
companies though.
> While both bills require everyone have health insurance, how they get
> it is different.
>
> Abortion coverage is a sticking point - there is no telling what will
> happen with that.
I've heard about that and it has me worried.
--
Mo