The ill get sicker.
Just as the last decade has displayed the trickle up economy with income distributions widening along with increases in the number of families living in poverty, so goes the "health distribution."
As I stated in previous diaries, we treat money better than we treat our fellow citizens, and as it should be no surprise to anyone that policy follows the money. There has been a big push for Health Savings Accounts and "Consumer Driven" health care and while these have an appealing charm, remember to follow the money.
Below the fold are clips from a well reasoned article I recieved from MedScape, an excellent medical news feed.
Note: There was an online poll on MedScape 70% favor "some type" universal care.
First the Conclusion
Concluding Comment: A Path Best Not Taken
Consumer-directed care has the potential to catalyze much-needed changes in U.S. medicine, including price transparency, public reporting of provider performance data, and development of online and other media that analyze these data in disinterested fashion for the public. But the large hazard, for the less advantaged, is that the consumer-directed model will do the work of euphemism by rationalizing cost-sharing requirements that widen class and racial disparities in care. A lesser hazard is that spread of this model will encourage further fragmentation of the U.S. health care system, undermining efforts to improve quality by coordinating care. Those least able to navigate through fragmented systems—typically the least educated and the least prosperous—will probably fare the worst in this environment. And those most marginalized by language and cultural barriers, geographic separation, and persisting racial and ethnic bias will have greater difficulties than others with similar incomes. High cost sharing, moreover, creates "reverse Robin Hood" cross-subsidies within insurance pools, from the less advantaged to the prosperous, since the former are less likely than the latter to initiate cascades of care that eventually tap insurance coverage.
I agree it is essential that people understand the system. Those of us working in the system have a hard enough time understanding and during a health crises patients and families are at a near complete loss.
As I continue to state, policies and practices that are floating around are largely finance schemes and not real solutions to creating a better system. There is a constant internal battle between providers and administrators to balance between working for improved integrated care and projecting future finance issues. Meeting after meeting discussing projected effects of "consumer driven care," patient safety, pay for performance....
All more about money than about care, especially for lower socio-economic populations. For example, if provider groups are "paid for performance" (meaning higher reimbursements for better 1, 3, 5 year results), those that treat higher income individuals that are good consumers will choose the percieved better groups. Whereas those treating more difficult to treat (lower education, transient, non-compliant..) will without a doubt have "lower performance."
This starts tie together my previous diaries. The perceived "improvements" in practice in policies are not improving anything. The current trends in thinking really are just further segmenting the populations into competitive groups. The 160 million with privates will be paying more for more care and have more options. They will be better consumers by consuming more of a higher quality, but they will pay for it. At the same time the tails of the distribution, the young, elderly, and poor will get worse care, more medical errors (currently 50% of errors are with elderly patients) and more rationing as the 160 million drive up costs as they demand more expensive care.
Those that are paying for themselves, will also be paying for everyone else. Something will have to give way as cost increases under current trends. Policy makers and corporations are depending on the competition of segmented groups, to create a more politically and financially profitable system, but it is a recipe for disaster as well as being morally reprehensible.