Liberal Values Defending Liberty and Enlightened Thought

I receive reports from the Commonwealth Fund virtually every week which demonstrate the poor state of health care delivery in this country. This week’s report, Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families has received coverage in the mainstream media and blogoshere (here, here, and here). The study looks at purchasing private medical insurance and finds, “most adults who seek to purchase insurance coverage through the individual market never end up buying a plan, finding it either very difficult or impossible to find one that met their needs or is affordable.” Of course you can read the report for yourself. It would be more valuable for me to note the problems I see people having on a regular basis, which are consistent with this report:

Many people are unable to afford private insurance. Of those who do purchase, a large number are under-insured for one reason or another. Many have high deductible policies, which are increasingly common as part of health savings accounts. The problem here is that most patients do not want to spend money out of their own pocket, and see money in their HSA as their money which they are reluctant to spend. This leads to patients avoiding preventative care and routine care of chronic problems. This expense ultimately gets passed on to the taxpayers as the problems become expensive to treat years down the road when the patient is often older than 65 and on Medicare.

Many plans exclude coverage of pre-existing conditions. This makes sense from the point of view of the insurance companies who do not want someone to purchase their insurance two weeks before having that elective surgery they have been putting off for years. It is a major burden on those with chronic medical conditions which require treatment on a regular basis and cannot go without care for months.

Many plans do not include prescription coverage. Patients may make it into the office and receive prescriptions to treat them, but it doesn’t help them if they cannot afford the medications. I’ve also seen patients who have prescription coverage on paper, but their co-pay is so high that they are paying the bulk of the cost out of pocket.

Many private plans do not cover routine office calls. For many relatively healthy adults this isn’t a serious problem, but for those with the chronic medical problems I typically treat, lack of coverage of office calls is a major burden. For example, landmark studies in the United Kingdom have shown a considerable decrease in diabetic complications among diabetic patients who received intensive treatment, including frequent office visits, as compared to those receiving conventional care. The typical under-insured patient in the United States doesn’t even receive treatment at the levels of those in the “conventional care” group in the UK studies. As with those with high deductible policies, the consequences of this are seen years down the road, often when the patient is on Medicare, unnecessarily increasing costs at that point. It is far more expensive to treat a patient who requires bypass surgery, dialysis, amputation of a limb, or rehabilitation following a stroke than it is to prevent the complications with routine care.

While these problems are commonly seen with those who must purchase their own insurance, I am increasingly seeing patients with policies obtained through their employer which have the same limitations. To a growing degree, this is a problem which is affecting a large percentage of the population, and with the trends I am seeing even those who currently have good insurance coverage should not be over-confident that this will continue.