Seesaw effect overturns false health care 'wisdom'

Common wisdom teaches that those who have health insurance get the care they need when they need it, and those who don't have coverage don't get care.  This false "wisdom" is used by progressives to push for government-controlled, single-payer health care. 

Evidence proves that this wisdom is unwise.  In fact, it is 180 degrees wrong. 

Texas has the highest uninsured rate in the U.S. at 17.1 percent and a Medicaid enrollment of 16 percent.  New York State has the lowest uninsured rate, 5.4 percent, and Medicaid enrollment almost double that of Texas, 32 percent.

Thus, Texas and New York are polar opposites with regard to health insurance.  Texas has the most uninsured and the fewest individuals with government-supplied, no-charge health insurance.  New York has the fewest uninsured and the most Medicaid enrollees.

How successful are New York and Texas in providing care?

Two useful indicators of access to care are wait time to see a primary care physician and meeting the primary care needs of state residents.  A large national survey performed in January 2017 by Merritt Hawkins provided useful data on these two measures.  

Wait times for primary care in New York averaged 28 days.  Dallas, Texas had the shortest average wait time in the country: 16.5 days.

New York, with the lowest uninsured rate, satisfied the primary care needs of its population 45 percent of the time.  Texas, with the highest uninsured rate and the lowest Medicaid enrollment, met primary care needs of Texans 71 percent of the time.

Put simply, having insurance does not assure timely care.  Worse, there appears to be an inverse relationship, a seesaw effect.  As the number of people with coverage went up, especially government supplied, no-charge Medicaid coverage, the harder it was to get care.  And the state with the highest uninsured population did the best at providing care.

To understand this counterintuitive result, follow the money trail.  When the government offers no-charge insurance to more people, such as Medicaid expansion, it costs money.  That government money goes to insurance companies for a list of benefits.  The federal dollars are not paid to providers for care.  The federal government issues reimbursement schedules that establish fixed payments to physicians, and insurance companies generally follow these payment schedules.  Since fewer and fewer physicians are willing to accept these low payment schedules or are willing to spend the time satisfying the federal bureaucratic burden, fewer providers are available to care for the government-insured patients.

In Maryland, a 12-year-old boy named Deamonte Driver died of a dental cavity because no local pediatric dentists would accept Medicaid insurance.  In Illinois, 752 Medicaid enrollees died waiting in line for care.  In the VA health system, "47,000 veterans [covered by Tricare federal insurance] may have died" waiting for medical care according to an internal VA audit. 

Americans need to be wary of any proposal for federal control of health care, whether it is called single-payer, Medicare for All, or universal health care.  Promises for "Universal Coverage," as in Section 102 in the Medicare for All bill, H.R. 1384, may deliver insurance coverage but fail to deliver care.


Popular wisdom is wrong: coverage does not equal care.  Having insurance does not guarantee access to care.  Being uninsured does not mean that one is unable to get needed care.  The media's focus on the uninsured rate diverts attention for what matters: access to timely care. 

Any policy recommendations advanced by politicians or experts should be judged on proof of access to care rather than vain promises of greater insurance coverage.

Deane Waldman, M.D., MBA, is professor emeritus of pediatric, pathology, and decision science; former director of the Center for Healthcare Policy at Texas Public Policy Foundation, and author of Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.  Visit him at "We Can Fix Healthcare." 

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