How To Measure The Real Health Care System Effectiveness

Dr. Deane Waldman argues from bitter personal experience that wait times are the true measure of health care system effectiveness, not the insured percentage of the population or the patients' costs of health care services that politicians and journalists focus on:

https://spectator.org/wait-times-for-medical-care-matter/

Wait Times for Medical Care Matter
The amount of time it takes to see a physician is the best measure of health care effectiveness.
By Deane Waldman, M.D. - June 22, 2024

I am sick and tired of reading headlines about the uninsured rate (i.e. the percentage of people who don’t have health insurance). When it’s down, pundits say Obamacare is working. When it’s up, Democrats claim it is Republicans’ fault for ruining healthcare. Americans care only because that’s what is shouted in their ears and constantly before their eyes: uninsured rate, uninsured rate.

Maximum average wait times for care increased after the ACA to a medically dangerous 122 days for a primary care appointment.

The goal of healthcare is not to have everyone insured. A healthcare system exists solely so provide the services of a medical professional. Not the promise of care but the reality of care, when patients need it.

Complicit media has successfully sold snake oil. They make us believe that coverage — a health insurance policy — equals medical care. If you have the former, you will get the latter. Evidence proves precisely the opposite.

First, people who have no insurance get care through the Emergency Medical Transport and Labor Act of 1986. EMTALA requires hospitals to provide urgent or emergent care for all persons regardless of whether the patient has insurance or does not, i.e., whether the hospital and doctors will be paid for care provided, or not. (READ MORE from Deane Waldman: Government Health Coverage for Illegals is a Bad Idea)

Second, people who have insurance, particularly government-provided insurance, often wait so long for care they die while waiting in line. Such death-by-queue has been reported in Medicaid enrollees as well as veterans covered by Tricare.

The false promise of coverage equals care is exploded by the seesaw effect. As the number of Americans with government insurance goes up, access to care goes down! This inverse (and adverse) consequence is proven by two facts:

1) As Obamacare expanded the Medicaid rolls, fewer doctors were willing to accept these patients for care. Approximately 30 percent are considering early retirement. More demand (for care) with less supply (fewer care givers) produces the seesaw effect.

2) Maximum average wait times for care increased after the ACA to a medically dangerous 122 days for a primary care appointment.

Another metric commonly thrown at the public is cost. That medical costs are too high is obvious by simple observation, by painful direct experience, and by the number of bankruptcies induced by medical bills. When Washington fixes prices, viz., for drugs in Biden’s falsely titled Inflation Reduction Act of 2022, they claim to “make healthcare affordable for all Americans.” Like the mirage that coverage equals care, fixing prices does not make medical care more accessible, in fact, just the opposite.

Price fixing by the government, no matter what is being price-fixed, invariably produces shortages and low quality. History has proven this economic fact. Recall the long lines of people in the U.S.S.R. waiting for “free” shoes, toilet paper, and medical care. Furthermore, fixing low prices for medicines will force pharmaceutical companies to cease research and development. So no new medical miracle drugs. Had Washington fixed drug prices back in the 1970s, today it is likely that children with leukemia would die instead of their 90+ percent cure rate.

Americans are already suffering from price fixing in medical professional services. What the public sees as exorbitant doctor’s charges make great targets for price fixing or even price transparency advocates. A physician’s charges are meaningless in the real world. Medicaid and Medicare issue “allowable reimbursement schedules,” which are lists of predetermined payments for care services, usually a small fraction of the actual charges. Insurance companies and health plans generally follow these schedules when contracting with physicians. And since Washington prohibits physicians from seeking the unpaid balance from patients, doctors are paid whatever Washington says, not what they charged.

When asked why they are refusing to see new Medicaid patients, doctors point to two factors: the low reimbursement schedules, often below their cost-of-doing-business, and the time-wasting, costly regulatory burden. Price fixing strikes again — hurting, not helping, We the Patients.

To offer the public a useful and accurate measure of how well our healthcare system is doing, do not offer the uninsured rate or fixed (low) prices for care. Show us the maximum wait times to get care. The title of an article in the British Medical Journal shows the danger patients face, “Every month delayed in cancer treatment can raise risk of death by around 10%.” Imagine what the current four-month delay is doing. (READ MORE: In Health Care, Job Growth Is Not Always Good)

This author does not need to imagine. My wife waited seven months to see her primary doctor for abdominal pain. The diagnosis was inoperable pancreatic cancer. She died 22 months later. Might her cancer have been operable if her wait time had been four days instead of seven months?

Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; former Director, New Mexico Health Insurance Exchange; and author of the multi-award winning book Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.