By Uwe E. Reinhardt
The New York Times, April 6, 2013
I recall addressing a group of New Jersey State legislators on this point a few years ago as follows:
“I teach my students that the price a buyer is willing to pay for a thing signals to suppliers of that thing the monetary value the prospective buyer puts on it. It is a basic tenet of economics. Leaning on that tenet, I conclude that the value you in your role as state legislators put upon the professional work of, say, a pediatrician, if applied to a poor child on Medicaid, is less than a quarter of the value you put upon that same professional work it applied to your own commercially insured children.”
Physicians clearly understand this relative valuation being signaled to them. According to a recent estimate, almost a third of American physicians are unwilling to accept any new patients covered by Medicaid.
Naturally, New Jerseyās legislators were not well pleased by my comment. To be fair, I doubt they had ever thought of their Medicaid budgets in that way. More probably, they tacitly assume that our health care system will give patients covered by Medicaid the same health care for a given medical condition that would be given a commercially insured patient, regardless how much legislators are willing to pay for that care.
Perhaps these legislators believe that the Hippocratic Oath, sworn to by all physicians at the onset of their careers, compels that egalitarian approach. In fact, neither the ancient nor modern version of the oath imposes on healers an obligation to treat patients at a monetary loss.
Americans today have a more, shall we say, ānuancedā view of the matter. One the one hand, we signal to our health care professionals vastly different valuations of their work. On the other, we expect them to be punctiliously egalitarian on their job.
In conclusion, I note that under the Affordable Care Act of 2010, the federal government is willing to pick up the added cost of raising physician fees paid by Medicaid for primary services to equality with the usually higher fees paid by Medicare for those services.
Alas, for the states, the federal government will pick up the bill for this policy only during 2013 and 2014. It is anybodyās guess, therefore, how many states will retain the more generous and to them costly payment policy after 2014.
Comment:
By Don McCanne, M.D.
Soon the nation be spending $3 trillion for health care. That is certainly more than enough to provide everyone with all essential health care services; that is, we can easily afford an egalitarian system.
Having spent a career attempting to provide care on an egalitarian basis, there is no doubt in my mind that it is impossible in our fragmented, dysfunctional system of financing care.
This is precisely why so many of us have become passionate in our advocacy for a single payer system. Yes, it would make life easier for dedicated health care professionals, but, far more important, it would ensure that all of us would have the health care that we need. The Affordable Care Act falls woefully short.
No system is perfect, but some are a whole lot more humanitarian than others.
http://economix.blogs.nytimes.com/2013/04/26/hammurabis-code-and-u-s-health-care/?ref=healthcarereform