Americans have developed the attitude that there's something wrong with expecting anybody to pay doctor bills out of pocket and it's killing us. It's the number one reason that medical care costs have been so out of control for so long that they threaten to bankrupt a once proud nation.
That's why it is so encouraging that Arizona AHCCCS (Medicaid) officials decided to charge a modest - $5 to $30 dollars - copayment for services to Medicaid beneficiaries in Arizona. That's also why it is outrageous that the notorious federal Ninth Circuit appeals court struck down Health and Human Services Secretary Kathleen Sebelius' approval of the Arizona program.
Back in my emergency physician days, it was not unusual for AHCCCS patients, typically single mothers with small children, to utilize the ER at night for the treatment of common childhood illnesses like colds and ear infections. They would sometimes even insist that in addition to the ill child being treated, the other children without symptoms be checked, too, "just to make sure."
Most of us would regard this cavalier use of expensive services as "ER abuse." But why criticize the mother? She was acting in a logical manner to the incentives she was given. Federal law allowed no co-pays (or refusal of service) for Medicaid patients, so there was no reason for her to seek less costly alternatives. The health planners in charge deserve the blame.
Medicaid patients aren't the only ones driven to overutilization. Most employer-provided insurance and Medicare supplemental insurance plans also insulate patients from the economic consequences of their decisions and reward doctors for doing more procedures.
Over the years, these policies come back to bite you. In spite of strenuous efforts to bureaucratically control costs by regulating payment schedules, Medicare and Medicaid continue to grow 7 to 9 percent yearly. Meanwhile, under Obama's ministrations, the overall growth rate of the economy is under 2 percent.
The math here isn't good. At this rate, Medicare and Medicaid spending would exceed our entire economic output in 40 years, although economic collapse would occur long before that.
But what to do? Arizona, with unusually generous AHCCCS eligibility requirements, is facing unbearable cost increases which threaten to crowd out other critical spending needs. We received permission to charge co-payments for services under a provision permitting the Secretary of HHS to grant waivers from Medicaid law for programs with a "research or demonstration value."
But a panel of the Ninth Circuit Court of Appeals, the most overturned, most ideologically left-wing court in the land, overturned the decision. They claimed the decision was "arbitrary and capricious." That's judge-speak for "we didn't agree with it."
They also claimed that the covert purpose of the program was really just to save money. Aw, come on. Even in Arizona they wouldn't do something so heinous, would they?
The court's legal reasoning was lame, since there would clearly be "demonstration value" in determining if co-payments could moderate the demand for medical services without compromising essential medical care. The ruling seemed grounded instead in the ideology of "welfare rights," the notion that certain members of society are entitled to being taken care of by the rest of us and that asking anything in return is immoral and probably illegal.
So the judges simply substituted their judgment for that of Secretary Sebelius and the AHCCCS officials struggling with exploding health care costs. But judges are terrible when they venture into policy-making because they don't have to deal with the economic effects of their decisions. They don't have to solve the problem of where to get the money to carry out their "compassionate" edicts. They don't have to worry about how many patients may have to be cut from AHCCCS so that the ones in the program can enjoy lavish, responsibility-free benefits.
Secretary Sebelius deserves credit for granting the waivers to allow co-payments. The Obama administration's instincts are that government can control health care costs by fiat, but she was at least willing to allow the state to try another approach.
Now she's been kicked to the curb by the arrogant Ninth Circuit court. Hopefully, this Court will be reversed yet again on a well justified appeal.
• East Valley resident Tom Patterson (pattersontomc@cox.net) is a retired physician and former state senator
TeaPartyPatriot posted at 5:46 pm on Tue, Sep 6, 2011.
"If a person is buying tobacco and booze, that person is paying some of the highest taxes in the nation. And, guess what, those taxes go to health care."
What? No sales tax on their crack?
NothingButTheTruth posted at 4:55 pm on Tue, Sep 6, 2011.
Rich, go back on your meds.
NothingButTheTruth posted at 4:52 pm on Tue, Sep 6, 2011.
Cerulean say thinks paying sales tax entitles you to free health care. Really, he really said that. Well not in so many words, but that is what he implied. What a maroon.
Cerulean posted at 4:41 pm on Tue, Sep 6, 2011.
The Catholic church allowed St. Josephs to use the title Catholic Hospital until Dec of last year when Thomas Olmsted, Bishop of the Diocese of Phoenix ordered a decree revoking consent that the hospital may utilize in any way the name “Catholic”.
To my mind this means that St. Joseph’s Catholic Hospital did have the consent of the church prior to that time.
Rich posted at 10:59 am on Tue, Sep 6, 2011.
St. Joseph's left control of the Sisters of Mercy, and the Church long before the era we are discussing. The Bishop no longer exercises control over it and hasn't for decades. Catholic Healthcare West is not an order of the Catholic Church.
Cerulean posted at 10:41 am on Tue, Sep 6, 2011.
Rich said, in part, “The government couldn't pay the church . . . .entitlement patients were gone”. Are you suggesting that religious hospitals cannot receive Medicare patients? St. Joseph’s of Phoenix was a Catholic hospital that accepted “group insurance” all the time. I do not know if St. Joseph’s also provided free births on occasion – I suspect it is so.
NBTT,
If a person is buying tobacco and booze, that person is paying some of the highest taxes in the nation. And, guess what, those taxes go to health care.
NothingButTheTruth posted at 5:23 pm on Mon, Sep 5, 2011.
We're tired not trying. Been a long labor day weekend. Lots of trout fishing and dove hunting. Trying to keep up with those youngsters is killing me, or keeping me alive. Not sure which.
NothingButTheTruth posted at 5:18 pm on Mon, Sep 5, 2011.
We're trying of paying through the nose to support all these freeloaders and then having them insult us for our efforts. Get it?
NothingButTheTruth posted at 5:16 pm on Mon, Sep 5, 2011.
Cerulean, you never get it.
NothingButTheTruth posted at 5:14 pm on Mon, Sep 5, 2011.
az homeless, maybe you can all use some of the money you spend on booze tobacco and dope to pay a little for all the free medical care us taxpayers pay for you.
Rich posted at 3:54 pm on Mon, Sep 5, 2011.
"I do not understand how insurance has anything to do with charity. What is keeping the Queen of the Angels hospital, or any medical facility grounded in faith and charity, from providing free birth services?"
It's a rather involved story, has a bunch to do with education as well. However, let's handle the late lamented hospitals. The government couldn't pay the church (churches, synagogues etc,) based on the separation of church and state. In other words, entitlement patients were gone. Group insurance, because the hospital was not recognized by the government, often forbade their use (And it was a bit self-serving in that it's hard to compete with cheaper services, such as those provided by friars and nuns who lived under vows of poverty). Thus the 'for profit' part of the hospital could no longer support the charitable side and the hospital became a private 'for profit' or 'not for profit' institution and tied to both insurance and entitlement rates. In short, big government and big insurance kicked St Gerard and St Therese to the curb. One of the reasons they can have 'healthcare' without breaking the bank in a good deal of Europe is that they did not. In fact, I once cut myself rather badly when I was in Milan. I went to a clinic of the Ospedale Maggiore, often cited as one of the first 'secular' hospitals. They sewed up the gash in my forearm, and bandaged it before they asked for any payment, and the bandaging was done by a nun, a Carmelite actually.
The Queen of the Angels, by the way, no longer exists. I know because I wrote for a birth certificate and was answered by the county, who eventually sent me a copy of my birth certificate with the wrong birthday, my mother had altered it to get me into school a year early. In other words, you don't know what you've got, until you lose it, and the government can't get it right, and doesn't seem to care much.
Cerulean posted at 9:30 am on Sun, Sep 4, 2011.
Rich,
“Insurance turned charity into profit, the government now demands a piece of the religious establishment, ….”
I do not understand how insurance has anything to do with charity. What is keeping the Queen of the Angels hospital, or any medical facility grounded in faith and charity, from providing free birth services?
Rich posted at 9:40 pm on Sat, Sep 3, 2011.
I was born in a hospital called the Queen of the Angels. If you couldn't pay, you were treated anyway. About the only thing you had to endure was a blessing, whether or not you were Catholic. Charity was a religious establishment then. And no one went untreated, unless they didn't come by. A good friend my age was born in a hospital named after Moses Maimonides, I don't know whether Rabbis give blessings, but it was basically the same thing, though the two hospitals were a continent apart. Insurance turned charity into profit, the government now demands a piece of the religious establishment, second hand with a little sophistry, they are doing what the founders of this country did their best to prevent, becoming the arbiters of life and death.
Cerulean posted at 3:34 pm on Sat, Sep 3, 2011.
Dr. Patterson wrote, in part, “Americans have developed the attitude that there's something wrong with expecting anybody to pay doctor bills out of pocket and it's killing us.”
When I was in my 30’s I went to my local Dr. for a diagnosis. He asked me ‘do you have insurance?’ I said ‘no, but I am willing to pay for any tests.’ He said, ‘I am sorry, I do not accept patients who do not have insurance.’ It was around that time that even my dentist began to require insurance.
You are correct Dr. Patterson “It's the number one reason that medical care costs have been so out of control for so long that they threaten to bankrupt a once proud nation.”
Meanwhile, on Aug 9th Secretary Sebelius awarded $28.8 million to small community health centers across the US. More than 19 million citizens will be served through these funds made available by the Affordable Care Act.
Watch this: http://youtu.be/OLlJd1uBkaU
arizona100 posted at 10:15 am on Sat, Sep 3, 2011.
Maybe it's time the Native Americans start paying their share of the free healthcare they get! The gov't pays billions a year for their care and they don't even have to pay for anything. Many natives who work refuse to purchase healthcare through their job because they can go to any IHS facillity and get it all for free.
How many years must us non natives be in this country before we are considered Native Americans and get the same health benifits????
And, if a NA is on AHCCCS american indian health plan, they get FREE transportation to all their medical appts.
one of the last posted at 8:56 am on Sat, Sep 3, 2011.
People going to the ER in place of doctors offices is not because of cavalier use of expensive services. it is because of the discrimination by the private doctors and AHCCCS system. The medical offices that refuse to acnolledge the patent even though the AHCCS plan requires that that be the only doctor that they see. the patents parent takes the patent to the ER to be able to get the patent in to see a doctor at all.
I had a noterized copy of the power of att. for my grandchild the AHCCCS plan assepted me as gardian to this grandchild . None of the individual doctors would see the child. The child has Asthma. I had no other choise but to take the child to someone who would treet the child. Now the child is with Mom and Stepdad and the Army is careing for the child.
I am not alone in this. Many of the patents on AHCCCS are in the same position for the same escuses by the AHCCCS plans and Doctors.
Fix the system and the patents will go to the primary care doctors not the ER.
The state will save a lot of money.
Co- pays dont save the healthcare system money. AHCCCS is not the Healthcare system. It is just a small part of it. Co-pays will only drive patents away from the doctors offices and they will wait till they are very seriously ill. then it will cost that much more when they do come in to the ER.
az homeless today posted at 7:10 am on Sat, Sep 3, 2011.
quit trying to run az you had your chance.you want to see lame take a good look at your self. go pick up a fishing pole and leave az alone there a fine line between being a fisher man and a idiot see witch one you are i bet idiot .what next kick a dog
az homeless today posted at 6:24 am on Sat, Sep 3, 2011.
1st if you think az on the right track .you dont know where the train going..tell me how there going to pay a co- payment.with what food stamps.oh i forgot they all have jobs.the ones you gave them when you where a senator.2nd did you think of the homeless family out there with children .not one or two or three kids .you know the ones that your kid left behind so the state of az have to take care of .and i wish they start instead of paying your retirement see how you like to live on two hundred a month for food and no cash for anything else like your co-payment
phylisskopp posted at 4:26 am on Sat, Sep 3, 2011.
My dad told me about "Penny Health" or something which helped him to find a lower priced health insurance (with ALMOST similar benefits) he is recommending this to me. Any suggestion? What do you think of them?