Thursday, February 12, 2009

Good News and Medicaid

Often, once periods or events in life have passed, it is far easier to look back on them and discuss them in ways you wouldn't think to while they were happening. Today, I'm going to talk about Medicaid, after last night's (not so serious, relax Mom) fun with Kayla.

I was laid off in the middle of July, and was informed that my health insurance would end at the end of the month. I had an option to go on COBRA to retain that insurance, and one of the wiser and more interesting aspects of COBRA is that it lets you take a few months to decide whether you'd have wanted it retroactively. As Serach was also not working at the time, having just had a baby and not wishing to return to her job as a full-time special education teacher, we went on Medicaid instead.

Last night, Kayla had a high fever and was coughing very harshly. She'd had a mild cold for a couple of days, and hadn't been particularly interested in drinking that morning, but she'd overall been happy and smiling until late in the evening. We'd gone on a walk with the girls earlier, gotten pizza much to the delight of both, and Kayla fell asleep on the way home. (Scary Elianna memory story: There was a young woman waiting to buy a headband from Serach at our apartment, who had stopped by once before for a few minutes. Elianna saw her and said "That's Elisheva, right? Remember when she came to our house?") We called the doctor after her fever came up as 103.0 and 102.9 over a couple hours, and after hearing her cough over the phone, he recommended not waiting until the morning and to take her to LIJ (and he gave us directions!).

Pobody's Nerfect did us a huge favor, leaving her (birthday boy!) husband Shake to come stay with Elianna, while we drove to LIJ's pediatric emergency room. I parked while Serach registered at the desk, and after a short wait, we were asked to come in. The details aren't particularly important, but essentially, despite overcrowding and a lack of rooms, we were extremely well taken care of, got fantastic care, and were actually home in less than 3-1/2 hours from when we left. It helps obviously that what she had is rather common and easy to take care of (croup - steroids to reduce the swollen area in the back of her throat and cool mist to breathe... total A-Rod jokes: Two in the ER, three since). The total cost to us: $0. It seems almost hard to believe, and it's great - we now know that should we ever have another problem, we can make a quick trip to the ER to get it taken care of.

This is also one primary reason why universal health care for the country is a horrible idea. Our ER trip probably cost the United States government a few hundred dollars. One can argue whether or not it is fair or a good idea for Medicaid to exist, and personally, I can argue both sides of that. But the statistics from Medicaid show just how much more likely someone getting something for free is to take advantage of what's there than someone who has to pay nominally for the same. According to the Kaiser Family Foundation:
Among the uninsured who would have been without coverage for the entire year, health spending would more than double, growing from $1,686 to $3,673 per person in 2008.
Better yet:
The visit rate for Medicaid patients (82 per 100 persons with Medicaid) was higher than the rate for those with Medicare (48 per 100 persons with Medicare), no insurance (48 per 100 persons with no insurance), and private insurance (21 per 100 persons with private insurance.
Now, there are some reasons why Medicare is so much higher (more likely to have more children on it, etc.), but 4x those with private insurance is astounding. It's especially so when you figure that a large percentage of those with private insurance are not exactly spending a fortune on the service itself: Most people either have a small co-pay or pay 10-20% of the cost of service. It is important to note that the argument is not necessarily that the people did not need the care at all; but people will seek out greater levels of care than necessary when they are not the ones footing the bill.

Now factor in the wait time - we were lucky and had a short wait time, but other people there were waiting longer. Even so, we and two other families were being serviced in an inner wait area while they waited for rooms to open up - and this at 11:00 at night. If the number of people were doubled, hospitals would go from never really catching up to simply not being able to care for patients. (In Canada, wait times and inabilities to get an appointment continually rank as the highest difficulties.)

Just two of the reasons why universal health care is a bad idea in the US, clear from just a single observation.