With a Democratic congressional majority behind him, President-elect Barack Obama is likely to make a universal health care program a reality.
What is universal healthcare? No one knows for sure. The idea is that every citizen has some kind of medical insurance coverage. But how is “some kind of” defined? Does that mean there will be coverage for catastrophes or acute problems that are life threatening and require trips to the emergency room? Or does that mean coverage for normal run of the mill physician diagnostic appointments for the flu which includes laboratory work and imagining like x-ray, ultrasound, CT scans and MRIs?
Once the extent of coverage is determined, the issue becomes how the health care system will operate. Will it work like Medicare or Medicaid? Will people be rolled into existing insurance plans that have different tiers of coverage? Will the plan be automatic for everyone with the option of having additional plans that the individual pays for to improve the kind of health care coverage they have? And then who will be responsible for paying for this?
Much is yet to be decided. However, one major issue has yet to be discussed. Will the medical community participate by accepting the insurance as payment for the services provided? There seems to be an incorrect perception by all in Washington that if it is offered, it will be accepted.
In our system, no provider is mandated to accept any form of insurance. It is an individual decision. Even Medicare is not an obligatory form of insurance for the providers. If the provider does not accept a certain type of insurance, the patient has two options: pay the difference between what the insurance plan will pay and the charge of the service or go somewhere else.
Unless a provision in the new legislation assures guaranteed fair reimbursements or tax credits for those medical providers who will offer medical services, I am afraid that you will see many medical providers opting out of the Universal Healthcare “network.”
Here’s how healthcare reimbursement works. If a medical specialist wants to provide healthcare services to a certain group of people covered by a specific medical insurance, let’s say for example, Blue Cross, the specialist must apply to become an approved “Blue Cross provider.” This means that you accept their payment as payment in full with or without required co-pay from the patient. When patients go to providers outside the “approved provider network,” Blue Cross will pay less money for the service, thus forcing their patients to pay the difference in full or to seek medical services within the network of approved providers.
In my office, a diagnostic audiologic evaluation (hearing test) costs $110. The procedure takes anywhere from 30-45 minutes. Medicare will reimburse us $54.11 for the test. We have to write off the rest of the money. MediCal, surprisingly, pays $66.00 for the same test. There are a few, very few, insurance companies that will pay 100% but most pay the same as Medicare. A few pay less. One of our companies pays only $19.26. We estimate that our hourly expenses to run the office (payroll, rent, utilities, insurances, office supplies, telephone, fax line, TDD line, cleaning services) are around $300. To break even, we must see 6 people an hour, which is impossible given the time that the test actually takes.
This scenario is the same in every medical office in California and in the United States. That’s why patients get 5 minutes of physician time or don’t see the physician and see a nurse instead. That’s why waiting rooms are overflowing. We have to see quantity and compromise on quality in order to break even.
Many physicians and healthcare professionals have decided not to accept insurance payments at all including Medicare. Some physicians have dropped participation in certain health insurances because the reimbursements are too low. This is all perfectly legal. Some physicians are charging an annual fee to be a member of their practice. Sure they lose patients, but then their practices are reduced to manageable levels and quality “old fashioned” kind of medical care can be provided. That is exactly what they are trying to achieve. Again, this is perfectly legal.
Enter some kind of universal healthcare system. Depending on the reimbursements, many providers may not be able to afford to see these patients and keep their doors open. It is possible that this kind of coverage won’t make any difference because no provider will agree to see the patient for the fees being offered. And so nothing is different except that the emergency rooms will get some pittance for seeing people.
I hope that the majority creating this new healthcare plan takes the needs of the providers into consideration so that we do not have another non-functioning government program to the detriment of all.