Monday, April 23, 2007
SWOP homepageFix N.M. health care? Don’t ignore our poverty
Cover the Uninsured Week begins today. I didn't realize we had a week like that. Can we name next week, Employ all with a living wage week? Or what about: Get water to Pajarito Mesa week.
Here's one in the spirit of the French Elections: House the homeless week.
Money & Medicine
WINTHROP QUIGLEY Of the Journal
The debate over health care change in New Mexico always comes down to two closely related questions: how to cover the 20-plus percent of our population that is uninsured, and who should pay the bill.We’ll be hearing a lot about these issues over the next few weeks. The annual Cover the Uninsured Week begins today. Consultants to state government on Thursday will release their evaluation of three proposals to bring health coverage to everyone. New Mexico First convenes a threeday “town hall” meeting on health care access and coverage May 3.
There is much more to health care reform than these perennial New Mexico concerns. Health care delivery is famously inefficient. Computerization has barely made a dent in providers’ offices. Studies show physicians deliver appropriate care only slightly more than half the time, and hospitals are dangerous to your health.
There are not nearly enough doctors, nurses, pharmacists or technicians. To keep up with population growth, we need far more providers who, if they are to be productive enough to be helpful, will practice in as-yet unimagined ways.
Those problems seem almost quaint in a state where more than 40 percent of the population is classified as lowincome, 400,000 people lack health insurance and 20 percent of children and 15 percent of working adults live in poverty. Much of what is wrong with New Mexico’s health care, including its uninsured population, is a function of that poverty.
“How do you build a system that addresses a population where 40 percent don’t have resources?” asked Lawrence H. Lyons, a physician with Santa Fe’s Presbyterian Medical Services.
Health care providers spend a lot of time dealing with social pathologies like teen pregnancies and violencecaused trauma spawned by poverty, which diverts time, resources and attention. Poverty is the reason so many people lack health insurance; people with good jobs get good benefits.
People without health insurance get demonstrably inferior care. They are sicker.
Their children are less likely to have insurance, even when the kids are eligible for publicly funded programs like Medicaid.
Uninsured people still need and get medical care. Service for which they don’t pay themselves out of pocket is paid through taxes or higher insurance premiums. Costs get shifted to people with insurance or eaten by health care providers; the costs don’t disappear.
Since enough payment doesn’t come from conventional insurance companies, New Mexico health care providers are in a continuous scramble to find someone to pay the bills. This results in a certain amount of tail wagging the dog. Providers sometimes set up programs not necessarily because they are needed but because a foundation or government agency will fund them.
That adds to the system’s inefficiency.
Government is the funder of last resort, and not just because people need care. Providers need revenue streams to pay for salaries, ever-more-expensive technology and infrastructure. As Presbyterian Healthcare Services CEO Jim Hinton observed, running a health care company in New Mexico is like operating an airline when you know that 20 percent of the people on the plane haven’t paid for their seats.
But upstream from the clinic and the hospital are the pathologies spawned by poverty. “A lot about health isn’t about health care,” Lyons said. “Before you get into health care, how do you raise the health status of the population?”
A kid on Medicaid will keep showing up with lung problems because the substandard housing he lives in is full of mold. A homeless guy keeps showing up at the emergency room with any number of complaints when what he needs is a job, shelter and help overcoming addiction.
All of the health insurance in the world, whether it’s underwritten by insurance companies or the government, doesn’t solve poverty. Until our reform efforts address poverty, we’re merely rearranging the deck chairs on the Titanic.
Winthrop Quigley covers health care and insurance for the Journal. You
can reach him at 823-3896 or wquigley@abqjournal.com.
Labels: health care, New Mexico, poverty
