President Obama will address a joint session of Congress on Sept. 9, urging lawmakers to give the green light to an overhaul of the healthcare system. His speech will be televised live. Here are some questions I hope he addresses:
“What healthcare system are we talking about? Is our current system so bad that it needs a complete overhaul? How do we know that the new system isn’t going to be more broken than the current one?
I look at Medicaid families and see injustice. I could never support a public program based on this system. What’s wrong with it?”
Asthma care for Medicaid families is not consistent with National Institutes of Health Guidelines for the Diagnosis and Management of Asthma. Our tax dollars supported more than 20 years of research and work to develop these guidelines. Our tax dollars also pay for Medicaid services to children and disabled or elderly adults.
Research shows us that using the Guidelines saves money and improves the quality of life for people with asthma. A report produced by the American College of Allergy, Asthma & Immunology demonstrates that asthma care delivered by allergists not only improves patient quality of life–it’s more cost-effective, too!
So why are so many Medicaid families kept in the dark about the details? Why must they suffer through countless emergency department visits without a referral to an allergist? Why is it that they can be intubated (an artificial means of life support) and released from the hospital without a referral to an allergist?
Talk to physicians who treat Medicaid patients. A great number of primary care physicians and allergists I’ve spoken with say they can’t afford to provide care to patients at the rate reimbursed by the government, so they provide free care to the few Medicaid patients they’ll accept.
Pay a visit to the Centers for Medicare and Medicaid Services in Maryland. It’s an enormous campus employing more than 5,000 people. A beautiful play yard and child care center is available for employees’ children; a Starbucks vendor and lovely cafeteria round out a healthy working atmosphere. But CMS outsources decision-making to three independent regional medical directors. These directors are the ones who decide what medications and services will be reimbursed—based on formulas that have nothing to do with the patient’s complex or chronic health needs.
They contract with pharmaceutical and device suppliers, some of which were knowingly swapping out patients’ FDA-approved nebulizer medications with illegal and contaminated nebulizer solutions. When AANMA brought it to the medical directors’ attention that they were paying millions of dollars to these crooks, we were met with silence. After making a presentation about the issue at one regional meeting, I asked the medical director for an appointment to discuss the matter further.
He scratched the side of his jaw as he looked at the wall behind me and said he didn’t have room in his calendar. After AANMA’s repeated attempts to resolve the issue through traditional means, we met with Sen. Charles Grassley, who immediately took action. Within a few months, a new rule came out of CMS that removed the financial incentive and reimbursement for these drugs.
The point here is that America is asking President Obama to involve us in the process. To listen to what is broken from our perspectives. To ensure that there will be no unintended consequences where the standard of care is lowered in the name of “saving money.”
It’s not enough to say that drugs, new technologies and diagnostic services, access to specialists and so on “cost too much.” We know that these tools save lives and money, and they don’t come for free. The money wasted on administrating wasteful programs, lost to fraud and tangled in bureaucracy is enough to provide quality healthcare to all Medicaid patients and reimburse physicians appropriately for their services.
We know that the fastest way to save money on healthcare expenditures is for patients and physicians to work strategically together. Patients don’t want to be patients. We’d rather get well, stay well and live well.
What do you think? Share your thoughts: nsander (at) aanma.org.