By: Health Insurance
Submitted: 2009-10-17 10:41:01 | Word Count: 942
Health care reform is on everyone's mind.
Twice since Labor Day, Democratic Gov. Martin O'Malley has participated in media conference calls promoting the Obama administration's centerpiece initiative.
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Earlier this week, Republican State Sen. Andy Harris of Baltimore County an anesthesiologist who is running again for Congress in 2010 came forth with his own narrowly tailored reform proposal.
What neither discussed, though, is the enormous problems any health care overhaul could create in Maryland and the rest of the country.
On the one hand, the current system is bankrupting the nation. For instance, in coming years, Medicaid costs are projected to rise by 7 to 8 percent annually in Maryland.
"That's unsustainable for the business of the state of Maryland and threatens to undermine all of those who do have coverage," O'Malley notes.
Yet on the other hand, any plan that dramatically increases the number of Americans with health insurance could cost Maryland and other states tens of billions of additional dollars they don't have.
Last year, Maryland expanded its Medicaid rolls to cover working parents just above the poverty level. The result: a surge in enrollment for managed-care organizations operating under the state's Medical Assistance Program. The groups' expenses tumbled into the red.
These MCOs also are struggling to find, and then retain, enough primary care physicians to handle this large infusion of new patients, who require a battery of expensive tests and treatment following years without medical attention.
Think what it will be like in Maryland if health care reform adds another 750,000 patients to the rolls of the insured. That's the equivalent of doubling the current Medical Assistance caseload.
The state puts $2 billion a year of local taxpayer dollars into the Medical Assistance Program. Will it have to double that amount? Ouch!
And where is the state going to find enough primary care doctors to care for all these newly insured patients? Maryland's meager reimbursement rates contribute mightily to the lack of interest medical school students show toward primary care careers. As older physicians retire, who will replace them?
Meanwhile, the state's nursing shortage persists. The demand will grow. Nurses will play big roles in caring for the newly insured, especially with the emphasis now being placed on preventive health programs.
President Obama says his reforms will not add to the national deficit. But he doesn't make that same promise for the states, which pay half the Medicaid bill. And thus far, there are no major provisions that would solve the shortage of nurses and physicians.
We could end up with a well-intentioned health reform package that collapses under its own weight.
There's no appetite among governors to increase state taxes to expand government health programs to cover more uninsured Americans.
Indeed, the normal gubernatorial response to greater Medicaid spending projections is to cut back on what states pays doctors and hospitals and to reduce services to these patients.
This year in Maryland, Medicaid payments were cut 2 percent to help close an earlier budget gap and a limit was placed on how many days sick Medicaid patients can spend in hospitals. What will happen if there are twice as many people on Medicaid?
The theory behind this reform movement is that once everyone can go see a doctor, it will save the system hundreds of billions of dollars by preventing needless deaths and hospitalizations and reducing illnesses.
But in the initial years, Medicaid costs could soar. Who's going to pay Maryland's share? How can this state, already deep in debt, cobble together an expanded health care program that doesn't break the bank?
Congress also has failed to consider that Americans don't like managed-care health insurance. It is too regimented and too restrictive in telling us which doctors we can see and when. Many people view HMOs as tantamount to health care rationing controlled by bureaucrats.
And yet, some sort of managed care program is precisely what will bring down medical costs. The newest approach is called a "medical home model: your primary care physician is paid to be your "medical quarterback," directing you to specialists, when needed, getting you into preventive care programs and checking up on you to ensure you stay in good health.
The sticking point is getting a decent reimbursement system in place. There's insufficient focus on that key aspect.
Can state governments afford to dramatically boost payments to primary care doctors and specialists in short supply? Will governors and legislatures continue to turn health care programs into piggy banks they raid in tough times?
What about private health insurers? How do you get them to give "medical quarterbacks" attractive reimbursement rates and reward doctors in general for keeping patients in good health?
This is one tough puzzle to solve.
Congress won't get it right the first time. But at least lawmakers have reached the point where health reform legislation may well pass. Then lawmakers will have to go back and fix what they got wrong if they still have the political courage to do so.
