This is the first of two articles about the good and bad impact of progressively desperate efforts to control health care costs. First up: the bad ideas.
With a urinary catheter sticking out of a hole cut into his windpipe, this guy was proof that desperate times call for desperate measures. He had been sent to the emergency department from his nursing home because a piece of food went down the wrong way and blocked off his breathing. Unable to Heimlich it out of there, a family doc on the scene cut open the old guy’s windpipe and jammed in the first hollow tube he could lay his hands on — the catheter.
America is now like that old man; gasping for relief from rapidly rising health care costs, with health care reform stuck firmly in our windpipes. With no national answer on the horizon, we are all turning back to our own desperate measures to keep alive each patient’s or family’s ability to afford their care, each employer’s ability to insure its workers, each insurer’s ability to sell affordable health insurance, and our state and national governments’ abilities to insure the poor and the elderly.
Irrational behavior becomes the norm when the norm is irrational and threatening. In the absence of a comprehensive, rational, national alternative for controlling health care costs on our behalf, we will be ever more likely to cut each other’s financial windpipes in order to save our own necks. We will sacrifice the long-term interests of our country, our health care system, anyone else, and even ourselves, for our short-term relief from financial — and other — pressures. We will tell anyone who objects to go suck air through a catheter.
Consider examples of this kind of response to desperation:
• A patient I saw in the ED recently told me how he pulled his own ingrown toenail out with a pair of pliers in order to avoid a doctor’s bill for the treatment.
• The internationally known Mayo Clinic, which takes patients from all over the world, has recently announced it will not take Medicaid patients from anywhere but Minnesota and its five neighboring states. Its primary care clinics in Glendale, Ariz., will no longer accept new Medicare patients. Both limits were put in place because Mayo does not make enough money on Medicare and Medicaid patients.
• The equally famous Cleveland Clinic recently announced it will not hire anyone who smokes. While its CEO said it was doing this because it wants to hire employees who model healthy behaviors, the real effect of the decision is to lower the Cleveland Clinic’s long-term employee health insurance costs.
• Many businesses are reluctant to hire back permanent, full-time employees as the economy recovers because of the cost of health insurance for those employees.
• In the last year, 33 states have cut or frozen Medicaid pay rates to hospitals and physicians, and 15 have cut benefits to Medicaid patients, according to the Kaiser Family Foundation.
• Medicare, desperate to rein in costs in order to avoid insolvency in the next five to eight years, is shifting more costs to Medicare recipients and ratcheting back payments to doctors and hospitals.
• Doctors and hospitals whose payments are cut by insurers may offset these cuts by taking privately insured patients over Medicare and Medicaid patients, ordering more tests and procedures and growing their way out of their bind.
• The state Senate of Virginia has approved a bill that would ban any mandate that everyone must be insured. If approved there and elsewhere, the effect could be to kill universal insurance, because affordable health insurance for all means even the healthy must buy insurance.
These have in common short-term gain for one party over another, lack of a long-term strategy to reduce health care cost drivers and potentially adding cost over the long haul. They have in common a fearful response to desperation instead of a thoughtful response. It’s time for us to think about what comes after the catheter for a breathing tube.
(Next: Good ideas born of desperation)
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.