Gingrich demands health insurance mandate for all who earn over $75,000

Ben Taub General Hospital in Houston sees one of the largest patient populations in the area. People come to it from the entire county, and many are uninsured. According to its Web site, "The Ben Taub Emergency Center is the source of eighty percent of all admissions to the hospital, which provides patients with access to more than 40 medical specialties. Ben Taub has more than 26,000 adult and pediatric admissions and more than 184,000 specialty clinic visits."

Yesterday, former U.S. House Speaker Newt Gingrich was in Nebraska talking about health care and health insurance to Alegent Health, a hospital system in Omaha. Gingrich, who is the head of the Center for Health Transformation, revealed his solution to the health care crisis: insurance mandates for people who earn more than $75,000 a year.

According to BusinessWeek, Gingrich said it is

"fundamentally immoral" for a person who can afford insurance to save money by going without, then show up at an emergency room and demand free care. He said those who can afford insurance and choose not to buy it should be required to post bonds to pay for care they may someday need.

That's a nice sentiment, but it's not the real problem. The cost burden on emergency rooms is not predominantly from people who are earning $75,000 and more a year. Although the middle class is increasingly losing health insurance---which continues to rise in cost and lower coverage---the main people who rely on emergency rooms for low or no cost treatment are, instead, the people who earn significantly less than that and who are underinsured or have no insurance at all.

Where is the real burden and who shoulders it?

One of the best articles I've read on the health care crisis was in USA Today nearly a year ago exactly. It featured Houston and quoted neurosurgeon Guy Clifton, founder of the Houston-area group Save Our ERs, as saying, "Texas is the case study for system implosion."

If we follow Republican leads, let me briefly describe for you how the nation will end up (hint: look at Texas):

• Nearly a quarter of the population uninsured (30% here in Harris County, making the Houston metroplex one of the top ten for uninsured; keep in mind Texas doesn't regulate health insurance as some other states, such as Massachusetts, do so cost can be as high as the company wants and coverage as low as the company wants)
• Medicaid enrollment income limit is set to less than half of other states leading to a larger number of poor and disabled with no insurance at all leading to a 50% increase in ER visits
• Cut funding to CHIP

But lack of insurance isn't the only problem. According to the article, "The greatest demand for health care isn't in emergency rooms. It's at the clinics and health centers designed to relieve them." Health care providers and patients agree that getting seen by a doctor in the clinics can take anywhere from an all day or multi-day wait for a walk-in visit to several months wait for an appointment. Frustrated or frightened people who are sick or in pain will often opt to go to the emergency room.

In Houston, the Harris County Hospital District is helping patients figure out when to use a clinic versus a hospital and the Harris County Health Care Alliance is working on low cost insurance plans.

This fits in with Gingrich's goal of encouraging people to get preventive care, but again, doesn't solve the real problem.

I get paid by the hour. If I'm not at work, I don't get paid. Many uninsured people face the same situation. With a tight budget and family depending on that day's income, it's easy to see how people delay health care when they know it could cost them a day or more of work and income.

In addition to providing insurance, we need to ensure adequate medical coverage that cuts down waits and diversion rates---both are obstacles to patients receiving timely care, which ultimately leads to a high mortality rate, or, at the least, a sicker or more injured patient by the time the patient receives medical care.

It's interesting to review the public perception of current U.S. health care. For example, 62% believe we need health care reform and 64% believe the standards of health care are declining with 89% agreeing that costs are rising.

I believe that's indicative of the need to not just impose mandates from the outside, but also reveals a deep need to support the health care system from the inside.

Senator Obama's healthcare plan works comprehensively from two angles: provide insurance coverage (by mandate for children) and improve the health care system (both through better prevention and education and also through modernization of the system).

While stating measurement areas for accountability is fine---as most politicians do; they like to show strength by promising to hold feet over the fire---Senator Obama has pledged money (aka the ultimate solution) to help health care systems resolve issues. For example, he plans to "invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT."

That amount should cover not just cost of implementation (such systems have been in development and available for a while now) but also training and maintenance.

That makes this improvement possible.

So keep your eye on the prize, my friends. Don't let the attention or burden be shifted to the citizens because let's face it: that hasn't worked. The plan Obama has not only states the issues and sets accountability but also includes actual real, working plans that will enable improvement in access to better health care for all people.

Blaming the victims isn't going to solve the problem. Money and good planning will. So, Gingrich, back to the drawing board in your think tank. You need to think this through more thoroughly and see that slapping at the middle class solves nothing.

Julie Pippert doesn't believe in slapping, other than verbally, which she occasionally engages in at Using My Words and Moms Speak Up.

Comments

[hibikir]

I don't think that modernizing the health care system is really a solution to the issue. Most of the western world don't have spiffy tablet PCs for doctors to carry around, automated prescription systems or unified medical history files. Yet, they are cheaper and more efficient.

Until I came to the US, I had never had to wait 20 minutes to get a prescription filled at a pharmacy, seen $150 worth of prescriptions for an insect bite, or heard of medical billing as a career. High student loans for doctors are unheard of back home, people enter a 6 year medical school without having to work on another major, and there's almost double the number of physicians per capita.

Making the medical profession more accessible and simplifying the byzantine web of insurance bureaucracy is not something that will get the country big gains in the first 10 years though. I doubt any politician today can think that far ahead.

[Julie Pippert]

Hibikir, did you happen to follow the link to the worldwide poll about perception of healthcare? The other parts of the western world are calling for the same improvements for similar reasons.

But, you are comparing a privatized profit-based system to universal care, also a challenging comparison.

Shorter waits and lower prescription costs are also part of Obama's plan.

Modernizing the system will provide better holistic care and will improve medical care, which is one of the issues.

[forHealth]

Obama doesn't have any real working plans. His ideas are all theories at this point and it is more of the same drivel that comes from the insurance lobbyists. The only way for health care or insurance to be transformed is for insurance industry to self-implode. Perhaps then we can start over.