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    Sunday, October 17, 2004

    The Price of Seduction: The Kerry plan for healthcare is so seductive. Under the Kerry plan, not only will the lame walk, but not one child will go without health insurance. And most adults will have it, too. Under Kerry's plan, all kids living in families making up to $56,500 a year will qualify for government-funded insurance. Their parents will, too, if they make up to $37,700. It's almost impossible not to fall in love with the man with a plan like that. No wonder my nurse tells me a vote for Kerry is a vote for nurses. No wonder prominent pediatricians signed on to promote Kerry.

    But like most things that sound too good to be true, it is. We don't have to imagine what would happen under Kerry's Medicaid expansion plan. All we have to do is look south, to Tennessee to see the Kerry plan in live action. Since 1994, Tennessee has provided state-funded healthcare with the same eligibility requirements as the Kerry plan. Nine years later the state's governor was calling it the dragon that eats everything, and financial management consultants were warning that by 2008 the program would consume $9 out of every $10 in new revenue taken in by the state. That's a lot of money, money that won't be available for other essential state-provided services.

    And yet, despite spending all of that money, Tenncare patients still end up getting the shaft. In the grand American tradition, the program shunned rationing, covering everything from lava lamps to MRI's. The programs generosity, however, did not include doctors and hospitals, whose reimbursement rates are so low that seeing Tenncare patients is a losing proposition. As a result, access to care is a very real problem for Tenncare patients, some of whom have to drive 40 miles just to see a doctor. (And keep in mind, those are mountain miles.)

    And what about the children? Only 19% of pediatricians in Tennessee accept Tenncare, the lowest participation rate of any state in the union. As a result, over one-third of children enrolled in Tenncare have trouble finding a doctor. That's a very real problem. And one that's much more serious and damaging to a child's health than lack of insurance.

    But under Kerry's Tenncare National, access to care would be even worse. The median family income in the U.S. is $53,991. Three hundred percent of the poverty level for the average family of four is $56,500. Under Kerry, over half of America's families would qualify for the expanded Medicaid coverage. Which would mean that doctors would see their reimbursement drop drastically - to the point that they would have trouble staying in business. You can't squeeze blood from a rock, and the fact of the matter is that the safety margin of the average physician's practice is already razor thin, thanks to the medical liability crisis. And there's no reason to think that a Kerry/Edwards administration is going to enact any meaningful medical liability reform, not with donors like these. With most of the country struggling with rising malpractice insurance premiums, there's just no room for physicians and hospitals to provide mandated charity care for the middle class. The heart may be willing, but the purse won't allow it.

    The pincer movement of Kerry's healthcare plan and trial lawyer friends would squeeze doctors right out of the picture. Those physicians who can would retire early, as many already are. Others would probably leave medicine all together. Hospitals that can't make up the difference by soaking the rich would close, as many small community hospitals did under the onslaught of managed care in the 1990's. But in this case, it wouldn't just be rural and inner city hospitals, it would also be suburban and small city hospitals. Only the large tertiary care centers, like Mass General and The Cleveland Clinic, who attract the wealthy the world over would stand a chance. And the future would be even bleaker. Who wants to invest the time and money to go to medical school if it's financially impossible to pay back student loans? The healthcare industry is leading employers in the U.S. Fewer hospitals and doctors not only means less access to care - it means higher unemployment rates. A vote for Kerry is anything but a vote for nurses. And it certainly isn't a vote for children. More people may have healthcare insurance under Kerry's plan, but they'll have a much harder time finding somewhere to use it.

    In the last debate Kerry called our current healthcare insurance system high-priced but low-benefit. The implication was that his plan would be low-priced and high-benefit. But everything has a price, and Kerry's is higher than we can afford.

    UPDATE: An email from Tennessee:

    I am a resident of Tennessee and want to thank you for talking about the TennCare debacle. The way the program is set up makes it almost impossible for the state to change the requirements. What sounded like a good idea is horrible in reality. I only hope more
    people look at what the reality of a health care plan like this is before anything is done on a national level.

    UPDATE II: And read this, too.

    MORE: From a reader:

    An unintended consequence of Kerry's Medicaid plan is that companies offering health benefit plans--and whose bulk of employees make wages of $30-40,000--would be motivated to drop coverage since the government will be picking up the tab. Why pay for benefits that the government will provide them. At some level the economics of dropping health coverage will be advantageous--adding the government roll.

    UPDATE III: Another comment from Tennessee:

    You are obviously unfamiliar with the terrain in Tennessee. The eastern section is mountainous, however I live in western Tennessee and there is not a mountain in sight -- in fact, there are few hills. I understand the tendency to paint us all as "mountain folk" (with all that implies), but it simply isn't the case.

    My apologies to the people of Tennessee, but there was no slander meant. When people travel from the flat part of Ohio to Kentucky or Tennessee, they're always struck by how much longer it seems to take go a mile. It's as if the mapmakers measured them as the crow flies instead of as the mountain road turns. And by the way, people make the same, if inverse, mistake about Ohio. It isn't all flat farmlands. Some of it is almost mountainous. (Foothillish, really.)


    posted by Sydney on 10/17/2004 08:05:00 AM 0 comments


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