My Turn: Let’s do the right thing: expand Medicaid
Every day in our emergency department, we see people in need of immediate health care. Some of these patients are at Dartmouth-Hitchcock for routine care that could have been delivered in a doctor’s office; others are acutely ill from a condition that, if it had been treated earlier, would not have become so serious.
In a great many cases, these neighbors and fellow New Hampshirites are in the emergency department because they lack health insurance and can’t afford to see a doctor.
Anyone who has been in the emergency department knows it is not an ideal care setting. It is frequently noisy and chaotic and often involves long periods of waiting. It is also expensive. For example, one study found the average cost of a visit to the emergency department for a sore throat was $525, compared to $94 for treatment of the same condition at a medical clinic.
At that price and inconvenience, why would anyone go to the emergency department for a sore throat? Well, imagine you’re Mary, a 30-year-old mother, working two part-time jobs at minimum wage, with no health insurance. Mary’s husband has his own small contracting business but can’t afford insurance for himself and his one worker. The total income for your family of four is about $28,000, too high for Medicaid, but too low to afford to buy private. That’s how Mary and her 5-year-old son, with a sore throat and fever, end up at the emergency department.
Last year, Dartmouth-Hitchcock provided $188 million in uncompensated care. As a health system we absorb most of these dollars, but it also means higher insurance premiums for all of those who have or provide insurance and/or higher deductibles for employees and their families.
It’s an irrational system that can’t continue. You can’t afford it, employers can’t afford it, and as health providers, we can’t afford it.
At Dartmouth-Hitchcock, we are committed to creating a sustainable health system, focused on keeping people healthy and out of the hospital, and on delivering health care that is high quality, high-value, and less expensive. This involves new kinds of partnerships and collaborations to lower costs, getting the highest quality care possible, wherever you live.
In the coming years, care will be delivered in ways we’ve never imagined. Already, we are providing care in distant locations through “tele-medicine,” often with our partner physicians at Mayo Clinic. Smartphone apps and other technologies will replace visits to the doctor for routine blood pressure and cholesterol checks. Dartmouth- Hitchcock is committed to these technologies and others that improve access to the best care possible for our patients, anywhere, anytime at the lowest possible cost .
However, without insurance, uninsured New Hampshire residents, particularly those living at or below the poverty level, will continue to see the expensive option of an emergency department visit as their only route to health care. They will continue to lose out on regular preventive care, early intervention and disease management that would keep them healthy and improve their quality of life.
There are many pieces to solving the current health care puzzle.
For some of our citizens, like Mary and her family, an important piece of the puzzle is Medicaid expansion. According to the Kaiser Commission on Medicaid and the Uninsured, it would reduce the number of uninsured in our state by 41-50 percent, giving an estimated 51,000 of our neighbors’ access to insurance.
As I write this, the federal government is in a shutdown, caused by continued debate over the Affordable Care Act.
At the same time, health care exchanges are being launched. It is, to be sure, an unsettling time, and it is no wonder people are confused about where we’re going and what this all means for them and their families.
New Hampshire has always prided itself on its independence and fearlessness in doing the right thing. In the case of Medicaid expansion, it’s not only right for the uninsured of our state, it is a critical piece of reducing costs for those who do have insurance and ending the ongoing cost shift between the public and private sector. In a win-win situation like this, we should move forward to expand Medicaid.
Let’s do the right thing.
(Dr. James Weinstein is a spine surgeon and CEO and president of the Dartmouth-Hitchcock Health System.)