Healthcare Reform - We have Deserts
December 15, 2022
Mission
The Healthcare delivery system in the United States is a patchwork that leaves much to be desired. It is the most expensive system among the top 35 industrial countries and covers far fewer participants delivering lower levels of quality care than many of our peer nations. This blog will provide:
· Current problems in healthcare
· Actions you can take
· Background information on healthcare
· References.
Current State of Affairs – Healthcare Deserts
In this section of the newsletter we highlight problems with the current system that need to be addressed.
Healthcare infrastructure can be characterized as having adequate access to a hospital, trauma center, primary care physician, pharmacy and if necessary a low cost health center.
GoodRx Research has examined Americans access to these key components of healthcare and found that much of the country can do better. A summary of their research is listed in the references below.
Hospital Access
47% of US counties, containing 80M people (1/4 of the US), have insufficient hospital beds. When people live in such areas they may have to drive hours to get the care they need. COVID-19 demonstrated that when there are insufficient hospital beds available patient care suffers, diagnoses and treatments are delayed and unnecessary deaths and increased costs for late treatment are the result.
Trauma Center Access
40% of the US population (49M) lives in trauma center deserts, where they have to drive an hour or more to a center. When time is of the essence to save lives in that first critical hour after an emergency has occurred lives can easily be lost. In Montana, Idaho, North Dakota, Wyoming and Nevada the majority of residents live more than an hour from a trauma center and their lives are at greater risk.
Primary Care Access
Without access to a primary care physician, treatment for many serious conditions is often delayed until the condition is severe or untreatable and the cost is often exponentially more expensive.
One primary care provider to more than 10,449 patients is considered a primary care desert. This is 3 times the recommended case-load for a physician. 294 counties (13M people) live in such a situation.
Pharmacy Access
In 40% of US counties people live more than 15 minutes from a pharmacy. This tends to impact. The longer time it takes to get to a pharmacy the less likely it is that prescriptions will be refilled. According to one study about 1/3 of prescriptions go unfilled.
Low-cost Care
10M children and 20M adults make use of federally funded health centers. They are typically poor. There are large swaths of the US where the poor do not have reasonable access to such health care. Such areas include North Dakota, Nebraska, Kansas and Texas. In fact, in Texas 18.4% of the population lacks any kind of health insurance.
What You Can Do
You can call or email your Senators and say
My name is _________, I am a constituent and live in zipcode ________. We can all agree that we need better healthcare.
GOODRX has recently analyzed American’s access to health care and found it to be severely lacking for between 30% and 47% of the population. In fact, some states, like Texas, have more than 18% uninsured. This just demonstrates that access to healthcare can’t be fixed at the state level but needs the Federal Government to help.
I want the senator to give serious consideration to Medicare For All legislation, such as HR 1976, which seeks to eliminate healthcare deserts in the US.
You can call or email your Representative and say
My name is _________, I am a constituent and live in zipcode ________. We can all agree that we need better healthcare.
GOODRX has recently analyzed Americans access to health care and found it to be severely lacking for between 30% and 47% of the population. In fact, some states, like Texas, have more than 18% uninsured. This just demonstrates that access to healthcare can’t be fixed at the state level but needs the Federal Government to help.
I want the representative to give serious consideration Medicare For All legislation, such as HR 1976, which seeks to eliminate healthcare deserts in the US.
Background
The history of universal healthcare is a rather long subject. In each of these letters I will describe some of it so that over time you will see how we arrived where we are today.
Most of the industrialized world has some type of universal healthcare covering most if not all residents. The systems employed to accomplish this vary because the values that each country cherishes vary from each other. There are four major ones. Today we will discuss the Beveridge System
History-United Kingdom
The United Kingdom was pretty much devastated at the end of WWII. One of the important things the government did was to establish a national healthcare system so that people did not have to worry about going to the doctor while they went about rebuilding the country. In 1948 Sir William Beveridge proposed a national health care system in which the government was the single payer or insurance company. The system is funded by the national sales or value added tax (VAT). It was designed with a cultural imperative important in England – “No Cost at the Point of Service”. This was to encourage people to use the system and stay healthy. Healthy people could rebuild the country and create a healthy economy.
There were concerns that such a national healthcare system would be subject to overuse and become exceedingly expensive since everyone could now seek care. When such systems are put in place experience now shows that the first year there is increased usage as people become aware that they have healthcare but usage normalizes at lower levels quickly. Also worth noting is that universal healthcare systems typically reduce overhead to make themselves more affordable. In the UK people are more willing to seek care earlier because they know they will be treated, not excluded, for discovering a serious pre-existing condition.
An important feature of most universal healthcare systems, including the UK’s National Health Service, is that public health is easier to manage. This was evidenced during the COVID-19 pandemic where vaccinations were available early and there were high rates of vaccination largely due to the high level of public trust in the system.
References
There are a number of important references to keep handy
Health Care Deserts - Source for the report above - https://hitconsultant.net/2021/09/10/healthcare-deserts-goodrx-report/
Kaiser Family Foundation –a good source of current data and problems wisth healthcare.
Physicians for a National Health Plan (PNHP) has a number of good background presentations and often describes actions you can take.
The Commonwealth Fund, a good source of healthcare research.
Robert Reich just put up a brilliant post about the zero sum economy of the ultra-rich that drives the destruction of our health care system and so much else.
https://open.substack.com/pub/robertreich/p/the-economys-large-and-growing-unproductive
Alan,
Thank you for starting this blog. A national healthcare system makes so much more sense than any other solution. Yet Americans are so accustomed to our healthcare "industry," and it is so embedded in our business culture that they put up with it rather than demand something more. I believe that part of what keeps it in place is a set of beliefs. We've been taught that ours is the best healthcare in the world. There's a historic basis for this, which is our history of medical discoveries. But if the fruits of those discoveries don't reach almost half the population, their advantages aren't realized. Probably the majority of Americans have lost faith in all of our major institutions and don't believe they can achieve anything more, certainly not as large a vision as national healthcare.
I believe that the root of many of our national problems is corruption. Our healthcare "industry" -- the idea that delivering healthcare is a business -- is a result. And yet many believe in unregulated business because they feel to do otherwise would make the delivery of goods and services more expensive. This message has been delivered by raising the specter of communist totalitarian societies and labeling such approaches "socialism." It's either capitalism or socialism, a false dichotomy.
How do you establish hope in achieving the larger vision of universal healthcare while asking for solutions for its broken parts? Does an attempt to solve those parts reinforce a belief that the larger vision isn't achievable? What have you found when researching the messaging challenges?