Some Americans just don’t have access to health care. That statement is hard to understand for many people. Just get in the car and drive to your doctor’s office. Or, if you don’t have a doctor where you live then move somewhere else! People without money may not have a car and may live with relatives who don’t want to move. It is reminiscent of what Marie Antoinette said about people who did not have bread “Let them eat cake”.
The majority of Americans do have access to health care so why worry about those who do not? There are three reasons for concern; 1) we don’t like our fellow man to suffer 2) the care for people with poor access is terribly expensive once they do get medical attention.3) we have a system of care for the indigent which is very expensive and does not work well. Poor people who live in the Mississippi Delta get health care like a third world country and sometimes not even that good. In fact, a health care system copied from Iran is being used in Mississippi to try to improve access to care.
Just as an experiment, try to make an appointment with a doctor and say you don’t have insurance. Voila, no appointment. What if you have a sinus infection and can’t get an appointment with a health care provider? You go to the emergency room. Even though you have been admitted many times for heart failure you can’t get an appointment with a doctor so you run out of medication — back to the emergency room. You have a growth on your breast but can’t get an appointment. So when it smells bad you go to the emergency room.
One measure of poor quality preventive care and follow up care is the rate of emergency room visits and re-hospitalizations. Some communities do very poorly by this measure.
When looking at the health care system as a whole providing good access to care is a way to save money. But, in America we have lost track of those cost savings. If a hospital, in good faith, tries to prevent readmissions for everyone, poor and rich, they lose income. The community benefits and taxpayers benefit but the organization controlling the situation is penalized.
There is some hope in the idea of an Accountable Care Organization (ACO). That proposed system of care matches a population to an organization of hospitals and providers for care. A certain amount is paid per person per year to the ACO (similar to insurance but without the middleman). The ACO hospitals become overhead expense rather than cash cows and primary care providers that keep patients healthy are golden. At least the incentives are aligned favorably for Americans but whether the idea will work is yet to be tested on a large scale. If poor people are included in the ACO, access to care should be improved and cost may come down. Additionally, an ACO can be held accountable for quality — since health care providers work for the ACO considerable pressure to deliver a quality product can be applied, especially if customers get to choose which ACO to join.