May 27, 2018
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As ye waste, so shall ye want (care)

By Dr. Erik Steele

I had every intention of keeping my mouth shut when the Maine Legislature, drowning in the state’s medical bills for its Medicaid health insurance program, incomprehensibly voted down a mandatory motorcycle helmet bill last week. I was not going to point out that failing to save state Medicaid money by preventing injuries to motorcyclists who have or get Medicaid insurance makes no sense. I was going to take a pass on the tragedy of wasted lives, preventable brain damage, and all the blah blah that means so little compared to freedom of personal choice.

Events of the last few weeks, however, conspired to make me open my big mouth — again — on this issue. First, I was reminded repeatedly that money for health care is more and more a closed sum game, meaning when we waste money on one medical cost there is something else we need in health care we are going to go with-out because we wasted the money that would have paid for it. Second, a study just came out about motorcycle injuries in Maine during the years 2003 through 2006, and the human misery and financial waste it delineates beg for someone to toll the bell even after the legislative horse on this year’s efforts to mandate motorcycle helmets for all (they are now required for those under 18) has left the barn.

The closed money loop was perhaps best demonstrated in legislative testimony about the helmet bill. A state senator spoke of a patient whose medical bills for a motorcycle crash head injury have amounted to more than $10 million in costs paid by Medicaid (meaning taxpayers). If that injury had been avoided, and that $10 mil-lion not spent, any number of very painful cuts to Maine Medicaid that are now going into effect conceivably could have been avoided.

Instead of paying those bills, maybe Medicaid could have paid Maine dentists a bit more so more of my Medicaid patients would have had access to dental care. How about that as a trade for the right of “those who ride to decide”? Or how about the nearly $400,000 cut in Medicaid reimbursement to my struggling Blue Hill Me-morial Hospital, where we have been forced to lay off people in part because of Maine Medicaid payment cuts? Is it worth those jobs for the right of motorcyclists to waste money on avoidable head injuries?

The study of motorcycle injuries in Maine from 2003 through 2006 found that 2,628 Mainers were involved in a motorcycle crash over those four years; 82 were killed, and 398 were hospitalized. There were 208 riders who suffered head injuries, which accounted for most of the severe or critical injuries.

More than lives were unnecessarily wasted, however. Hospital charges for injured riders totaled more than $18.1 million. True costs were even higher; according to the study, “These charges represent only the initial cost of immediate care and do not reflect additional medical and other costs that may occur during the months and years following the injury.” About a third of those costs were for Medicaid or uninsured riders. Unless Maine heads are harder, helmets would have reduced the financial and personal toll for head injuries to all of these patients by about 40 percent.

The truth is, it’s not just legislators and motorcyclists who are the problem; we all are wasting money and refusing to make tough choices in health care. So the next time a tough choice about saving money in health care confronts any of us — legislator, health care professional, patients, etc. — we need to imagine a group of pa-tients right in front of us while we make our choice. If we waste money because we passed on the tough choice, one of those patients looking right at us will now go without care they need as a result of our decision. We must then explain that it’s OK for them to go without care so a motorcyclist can go without a helmet, or someone else to keep wasting money.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He is also the interim CEO at Blue Hill Memorial Hospital.

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