Healthcare Reform - Access is Everything
March 15, 2023
Happy Wednesday Healthcare Advocates
I am so thankful for all of you and for the actions you take to move us towards a universal healthcare system. I left the picture to fill in today’s cuteness quotient.
Access is Everything
There has been some research on what access means with respect to healthcare. According to Penchansky and Thomas, access to care is the 5 As:
Affordability, Availability, Accessibility, Accommodation, and Acceptability. Affordability and availability are pretty clear.
Accessibility refers to geographic accessibility, which is determined by how easily the client can physically reach the provider's location.
Accommodation reflects the extent to which the provider's operation is organized in ways that meet the constraints and preferences of the client such as hours open, telephone communication, and ability to drop in without appointment.
Acceptability is the extent to which the client is comfortable relating to the provider.
Here’s what we have instead. (For the data below the population of the US is about 330,000,000 and 60% of that population is 18-64, 23,430,000)
According to the CDC here is how we as a country are doing now (2021).
7.1% of the whole population did not take medicine because of the cost, 23,430,000.
6.3% of people over 18 did not go to the doctor because they could not afford it.
13.5% of the population aged 18 to 64 was uninsured, 27,000,000. That is outside of employer plans, ACA, and Medicaid.
According to Kaiser Health News 20% of the US population (66,000,000) live in rural America. In the medical desert that has become rural America, nothing is more basic or more essential than access to doctors, but they are increasingly difficult to find. The federal government now designates nearly 80 percent of rural America as “medically underserved.”
Let’s recap the industry side of things because many things need to be redesigned so the system will work. This idea of putting a bandaid on the problem that screams loudest and hope that things quiet down is not a strategy.
When I was a program manager I learned that quickly, hope is not a strategy, designing a solution is.
What needs to be fixed is complicated but can be done. Let’s recap.
We have insurance companies determining what treatment you can have because they have complicated relationships with certain providers. You might be able to see a different provider but the cost is sky high.
We have pharmacy companies that overcharge like crazy in order to pay kickbacks to pharmacy benefit managers to make sure their product is sold and that the insurance company will cover it - less your copay.
We have Pharmacy Benefit Managers that skim the kickbacks (instead making the drug cheaper) and cheat the insurance company and the pharmacy and the customer.
And we have health care facilities that charge a bundle for care and some that even cheat. Look up Healthcare of America, one of the largest in the US, caught cheating Medicare and Medicaid and was fined 1.7B (under Rick Scott’s leadership). Of course he’s a senator from Florida now.
Here is Congresswoman Pramila Jayapal’s HR 1976 Universal healthcare for the 117th congress She will be introducing this again shortly.
It contains a special budget provision for staffing up rural facilities, for building up new facilities and for maintaining existing facilities. It contains payment provisions that cover facilities through global budgets - ensuring that there is enough to keep facilities open and it has fee for service payments to providers as needed.
No copays/deductibles, long term care included, and far cheaper than what we pay now according to the Congressional Budget Office. Major industries with competitors overseas will be able to compete far better without the high priced burden of providing health insurance.
Let’s be clear. This is not socialized anything. It is a single insurance company paying the bills of private providers. This is a designed system that addresses the problems we are facing everyday instead of a patchwork of everyone’s favorite band aid.
What it provides is access for all of us, cradle to grave.
But there is one more truth to absorb. Congress won’t do it unless they hear that it is really important for all of us, over and over and over. The healthcare industry gives hundreds of millions of dollars to politicians to keep the system in their favor, not yours. Politicians have to know they will lose their jobs unless they act.
Make them act.
WHAT YOU CAN DO TODAY
RESISTBOT
Text SIGN PWIVZV to 50409 to send your Congressperson, Senators, and the Whitehouse this message (or use it on the phone or copy and paste it to email - Links are in the resources below)
Congresswoman Pramila Jayapal will be bringing her Universal Healthcare bill back to Congress shortly. I strongly support this bill and I want you to support it as well.
The bill will lower costs, provide better, higher quality care to everyone (urban and rural) and make us as competitive as we can be in the world market.
It addresses providing care to the 20% of Americans that live in rural America by building up their healthcare infrastructure. It creates global payments for medical facilities so they don’t have to worry about having enough to keep their doors open. It creates fair plans to pay providers and to purchase prescriptions.
This is the healthcare infrastructure America needs and I again strongly urge you to support it.
What are you waiting for? We need you to do this now.
Resources
Contact White House or other federal agencies: usa.gov/federal-agencies
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
https://www.commoncause.org/find-your-representative/change-your-address
Contact all members of Congress
By phone: (202) 224-3121
By email: democracy.io
By US mail: Representatives / Senators
By fax: Representatives / Senators
By Resistbot: Resist.bot
Thanks Irene. I heard the news about Jayapal's bill from a Dr. In HCRRUS who got it from her office. Good to know about whose data to trust.
I sent the message. I added "It will save many lives." That is my informed opinion. I would expect there is some research to support that. Having worked in managed care from the time it started and being involved with reporting on the 5 A's, the survey data submitted by managed care entities to CMS is not great. I would not expect it to jive with Kaiser Research, whose data I trust.