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Is Universal Insurance Really the Answer?

A recent article by Mary Ann Roser in the Austin American Statesman is causing consternation. The article is headlined, "Austin ER's got 2,678 visits from 9 people over 6 years." The article says, "All nine speak English; three are homeless; five are women whose average age is 40, and four are men whose average age is 50. Seven have a mental health diagnosis and eight have a drug abuse diagnosis." The cost of these visits is estimated at $3 million. The article doesn't say whether they have insurance coverage, but it does mention that Medicare and Medicaid helped pay the bill.

Actually, we know that the people "clogging" emergency departments are not the uninsured, but people on Medicare and Medicaid. Research shows the uninsured visit ERs at a rate lower than their presence in the population. One of the fallacies of the current obsession with "universal health insurance" is that there is a significant portion of the population who will never be able to cope with any kind of "insurance." They may be illiterate, mentally ill, drug addicted, criminal underground, or otherwise dysfunctional. They cannot read or understand an insurance policy, cannot file a claim, cannot distinguish between par- and non-par providers. Many of these people are on Medicaid today and still just show up at the ER when they feel poorly. They don't understand there are alternatives. These folks need health "care," not health "insurance."

Dr. Deborah Peel, president of Patient Privacy Rights, offered this perspective:

"What happens next to these 9 people who are not wanted at Central Texas hospitals? Will the public come to know who they are? Will this story lead to them getting the complex, long-term expert care they really need?

"Their privacy has been violated, even without the reporting of their names (so far), but will singling them out as costing the community $3 million/year cause the local health system to change and seek solutions to treat them effectively or will the public get outraged at them? As a cynic/realist, I fear the care these 9 get will worsen as a result of this story and the violation of their privacy will have not served their good or the public good. Violating someone's privacy to uphold an important long-held key principle of medical ethics, such as saving a life, is clearly justified, but will a greater good or ethical principle be served by this report?

"As the former Chief of Psychiatry at Brackenridge Hospital in Austin for 11 years, I am well aware that Central Texas has extremely poor mental health and addiction services for people on Medicare and Medicaid (few private practitioners will treat people on Medicare or Medicaid because the pay is so low and the state MH system is massively inadequate).

"Hospitals do identify 'frequent flyers,' try to hustle them out, try to avoid treating them, or try to dump them ....and often end up blaming the patients for their problems. When a few patients have such high numbers of visits, they inevitably become very well-known to the staff. The problem is homeless people and people with mental illnesses or addictions also have a very high rate of serious medical illnesses too, which studies show are typically poorly treated or not diagnosed. Some ER staff come to feel so negatively about them that the quality of care is affected and they suffer and die from undertreated medical problems.

"20 percent of patients account for 80 percent of the costs in the healthcare system. But people with complex, hard to treat mental illnesses or addictions are not usually viewed as needing or deserving expert care. Patients with all other complex medical illnesses typically have access to highly trained specialists because reimbursement by Medicare, Medicaid, and private insurance comes much closer to the what treatment actually costs to provide. The new federal Parity law appears not to have helped much in Central Texas, nor can the strong negative attitudes toward mental illness, addiction and severe personality disorders be easily erased."

Read the Opposing Views debate, Should the U.S. Have Universal Healthcare?


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