The latest comprehensive report on health conditions and the stastus of health care – access, cost and the overwhelming burden of the uninsured and underinsured – in the six-county Chattanooga metro area is bleak enough to give any forward-looking person the shivers.
The report, compiled by the Ochs Center for Metropolitan Studies, details the rising public impact of increasingly unaffordable health insurance, the stunningly broad numbers of area citizens who are forced to rely on public and charity care, and the precipitous decline in the ratio of commercially insured patients versus the publicly insured and the uninsured in hospital admissions.
The report cannot be seen as merely a warning shot across the bow of those who are indifferent to what has already become a deeply entrenched health-care crisis. Rather, it is a description of a crisis in full motion – a crisis that is rapidly worsening as the most cynical right-wing politicians ignore or play politics with it.
Alarming trends
Consider just a few of the most alarming findings:
– The number of uninsured admitted to hospitals here more than doubled between 2004 and 2008, rising by 123 percent.
– In 2009, the number of uninsured combined with the publicly insured (those on Medicare, Medicaid or SCHIP, the state’s children health insurance program) accounted for nearly 7 out of 10 hospital patients.
n Between charity care for the uninsured and below-cost reimbursements from public care, their care caused hospital charity costs to zoom in the same period from $34 million to $91 million, of which $81 million came at Erlanger Hospital.
– That uncompensated cost is forcing hospitals and doctors to shift more of their costs onto the premiums of commercially insured.
– As these commercial premiums rise for people who are privately insured under employer-based insurance plans or individual private insurance, more employers and individuals are finding health insurance unaffordable, prompting them to drop their health care coverage.
A death spiral
“It’s kind of a death spiral,” says Craig Becker, president of the Tennessee Hospital Association. “The more people dropped, the higher the commercial rates go, and the more people dropped. …”
Other findings bear that out. In Tennessee, just over half of employers now help sponsor a health insurance plan for employees. Those that do tend to be larger employers, not smaller ones. That trend now leaves nearly half of Tennessee’s workers and their families without employer-based coverage, and few affordable options. That harsh dynamic, in turn, would portend a pending tsunami of uninsured Americans if, as they promise, Republicans manage to roll back or freeze implementation of health care reform.
Employers continue, moreover, to cut insurance benefits and cost-sharing proportions as insurance costs outpace inflation every year. And they reduce their share of funding even as they raise employees’ share of premium costs, which, at 22 percent in Tennessee, is already above the national average.
This undeniable health-care crisis is not unique to the Chattanooga area. It is the prevailing trend across the country.
And it is not just a problem for the increasing number of Americans left uninsured or under-insured in the health-care squeeze. It is most conspicuously a moral tarball for Republicans, who seem to pretend that just criticizing the administration’s health care reform plan will make the nation’s already dire health-care plight go away.
That’s crazy. Yet Republicans aren’t in the real game. They won’t offer a hint of a viable alternative for reform, and apparently are not prepared to do so. All they can do is criticize the efforts made by Democrats and President Obama in trying to address the rising problem of unaffordable health care and insurance.
Corker’s empty complaint
Sen. Bob Corker sadly demonstrated that approach here last week. He said the reform plan approved last spring by Democrats and the Obama administration won’t work because it will open up TennCare – Tennessee’s version of Medicaid – to more Tennessee workers and their families, and thus raise TennCare’s federal and state cost.
In truth, it may, at least until other reforms kick in. But insuring more Tennesseans is a good thing. It will provide help for citizens and families who otherwise would otherwise be in the ranks of the uninsured.
The cost issue can be best addressed by pressure on providers to hold down needless procedures and costs, by rules requiring insurers to shift more of their overhead costs directly to reimbursements for actual care rather than higher profits and executive salaries, and by regulations restricting self-serving procedures and fee arrangements (i.e., doctors’ ownership of imaging and lab services, which they often over-utilize and profit heavily from).
A host of other cost-saving practices, from improving the flow of medical records and physician collaboration to applying best-practice standards, will also have to come into play.
Where is a Republican plan?
In any event, the medical system must be changed, and improved. The cost and health care trends are otherwise too dire. High levels of obesity and related diseases must be addressed. More focus must go to wellness management and preventive care, and less to fee-for-service care.
The political dialogue, as well, must be turned upside down. Republicans who sow fear about the costs of reform should be made to speak about the current trends and the horrendous cost of doing nothing, of sticking with a broken status quo that is spitting more Americans out of health care every day.
That road leads only downhill, to Republicans making themselves the proponents of insurance company death panels, by leaving insurers to prosper by cherry-picking the healthy and denying care to the sick, and leaving too many to die from neglect. That’s really not the American way.