14 February 2008

Massachut... er, Massatchus, um, MA Health Care Plan

I've heard Kevin's criticisms that a universal health plan like the Massachusetts plan will do little to increase access to care so long as the number of primary care providers remains static (and probably inadequate even before universal health), and I agree with him. This is a consequence of the slow auto-amputation of primary care in this country, itself a consequence of the systematic underfunding of primary care. I couldn't agree more that it's a tenacious problem.

But it's not a problem due to universal coverage. Universal health is a partial solution, not a panacea.

One element of the MA plan that appear to be working as designed is that it has apparently reduced the burden on the regions emergency departments. The report indicates that the number of unfunded ER visits is down nearly a third. It implies that patients are not seeking care for non-emergent complaints, but does not back up the claim, and I rather suspect that the formerly indigent patients continue to use the ER for routine care as there are not enough PCPs for them. But, as an ER doc, I can take some satisfaction that "we" are at least now getting paid for those services, which will reduce the need to cost-shift the expense onto better-funded patients.

Ezra blogs over here
about the fiscal controversy surrounding the plan, perhaps best summarized as "it's a victim of its own success."

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