SCMA: Working for You

Who Will Care for the Rest of Us?

By SCMA President Brad Drexler, MD

Although California’s economy is the eighth largest in the world (with one-tenth of the world’s billionaires), we will soon become the 50th lowest state in terms of Medicaid reimbursements. The Legislature’s recent decision to slash more than $1 billion from Medi-Cal will only exacerbate the health care crisis for millions of needy Californians, and it will threaten medical services in Sonoma County, which is already near the breaking point.

Although these cuts will hurt patients, they may not even cut costs. According to a report by the Legislative Analyst, the cuts will reduce federal matching funds, and loss of primary care access will cause a shift to more expensive forms of care.

Yet we know that putting resources into health care is effective. For example, the United States is 30th in the world in terms of infant mortality, but California has decided that prenatal and infant care are important, and it has funded essentially universal, appropriate coverage. Locally, SCMA, the SCMA Alliance, and the county’s DHS have worked hard to provide prenatal and infant coverage and programs. In the most recent statistics available (2004), we can be proud that Sonoma County’s infant-mortality ranked the best in California. As of this writing, that rate made us number one in the world (2006).

I worry that our health care crisis will become so untenable that voters will get fed up and institute a single-payer system. I fear that single payer would take us out of the frying pan and into the fire. Having family in the UK and Canada, I know these countries are not immune to our problems with rising costs and appropriate access. On a recent trip to the UK, it was chillingly close to home to see signs in nearly every small town saying “Save the Local Hospital.”

Even though of modest means, my brother and sister-in-law in London recently paid the equivalent of four times the size of my delivery fee to have a “private” ob-gyn deliver her baby in the private wing of a public hospital (as does apparently any couple there who can afford it). Certainly it is hard to look at Medi-Cal, the California prison health program, or federal military health programs and be impressed with how they are running health care. As humorist PJ O’Rourke says, “If you think health care is expensive now, just wait until it’s free.”

I recently turned 50, and I received a letter from my insurance company rewarding me with a 25% increase in my rates. Even though I’m in good health, the insurance companies have made underwriting so onerous that it has become almost impossible for any individual to qualify for affordable health care. In essence, there is no longer any competition in the marketplace.

Unfortunately, the Legislature decided to consider no other health care legislation this past year while dealing with the health care reform bill recently killed by the state Senate. We have ended up with no reform whatsoever, not even the easy but necessary changes of health care for all kids, coverage guarantees, or insurance reform. There is no political will to get anything done at all, and no one in our government standing up for the dispossessed.

An acquaintance recently told me that her physician had retired, and it took calls to 14 primary care offices to find one that was accepting new Medicare patients. Things are much worse for Medi-Medi patients (poor seniors or the disabled). Luckily, Medi-Cal patients are able to access the safety-net clinics, but even there specialty access can be quite difficult.

The same could be said for patients with Blue Cross, Blue Shield or United Health Care, which are now paying physicians at or below Medicare rates (or in the case of UHC, not paying at all, according to a recent suit by NY Attorney General Andrew Cuomo). Access to health care has now become a concern for all of us.

In a recent interview about opening a play on Broadway, musician Heidi Rodewald said, “It’ll be something to look back on rather than to experience.” I think this is the only positive take I can have on our current health care situation.

It is time that we make a priority of taking care of our needy and sick, as well as health care access for all of us, and let the legislators know that their jobs depend on it!

Health care access is no longer just a concern for the needy or uninsured, but also for everyone else. We have all become “the rest of us.”

And who will take care of the rest of us?