Re: ObamaRama 8
ER visits will only decrease because of increased access to primary care. Having insurance and being able to afford that care is only one part of the picture. Without access to that primary care provider, the patient must seek that care elsewhere such as an ER. One could conceivably argue that with that new found insurance and no regular Dr., it's actually easier to go to the ER for those patients. Mass. currently has one of highest ratio of Drs/patients in the nation so availability of that primary care is also very high. Despite the greater insurance coverage, greater income, and more physicians than most of the country, ER visits have increased in Mass. (as has overall costs). The, albeit preliminary, data from the Mass. initiative suggests that it has not gone as well as expected. This in a state, that I'm sure we would both agree is in much better fiscal shape than most. Why then, is it wise to promote a similar program on the remainder of the country and not obtain more data/trends from the Mass. program to see if it truly works? One doesn't have to be a medical professional to realize that it would be unwise to ignore even preliminary data that strongly suggests ones current hypothesis is wrong, merely a congressman.
So we agree on one thing. More data is needed. As of now however, the only data available strongly suggests that the claim you made (that savings will occur due to decreased ER visits) is BS.
All reasonable points, however I'll counter your main question, which seems to be why do this now, with an answer rooted in politics. Simply put, there is no way you'll ever get this close for another generation, at which time the system will most likely be worse.
In an ideal world, you'd be able to wait, and take your time, and address the issue in a few years time if you made the decision to see how Mass played out. The problem is, whether you agree with this is the right thing to do or not, one political party has decided that its more advantageous for them to see this effort fail, regardless of its merits, because that will benefit them more politically in the short term. With that in mind, the only way then to move legislation is with a 60 vote majority in the Senate, something that's happened for the first time in 30 years.
Futhermore, if the current minority party becomes the majority, or attains the Presidency, given their track record over the last 30 years, there's little indication that health care reform will be anywhere on their radar screen. More likely, as they would have attained their majority status fighting to defeat health care reform, absolutely nothing will be done. Hence the impetus to get this done now.
What your describing reminds me of work in some ways. If you've ever dealt with an accounting team, those people will not rest until every last penny is accounted for, even if its a billion dollar organization. Deadlines mean nothing to them. Finance people on the other hand understand that you have to go with the best info you have at the time. If you're good most of the time you're right, but once in awhile you're wrong. It would be nice if you had time to account for every last cent, but in the real world it doesn't work that way. Similarly, in health care reform, it would be nice to do a multi year effort on this, and please everybody. Unfortunately, that's not the reality of this country's current political climate, and won't be for anytime from now to the distant future. The time to act is now.
