By George W. Chapman
“Vaccine hesitancy” is the term coined by the World Health Organization to describe the resistance to vaccination due to unfounded safety fears, complacency about infectious diseases or difficulty accessing vaccinations due to supply or price. Vaccine hesitancy is now listed in this year’s top 10 threats to global health. Lately, close to 200 people in New York, mostly children, contracted measles, according to the Centers for Disease Control. An ongoing measles outbreak in Portland, Ore., has sickened 23 people, mostly children. Twenty of them were never vaccinated. Incredibly, despite the overwhelming evidence that vaccines work, the rate of unvaccinated kids has quadrupled in the past 17 years.
Thanks to vaccines, smallpox has been completely eradicated and polio soon will be. Some children remain unvaccinated because of choices made by their parents. The American Medical Association is clamping down on providers who flippantly provide feeble excuses for children not to be vaccinated so they can enter school. The CDC is debunking the myths about vaccines.
No. 1: Numerous studies have found no connection between vaccines and autism. People might think the two are linked because the MMR vaccine is administered at the same phase in a child’s development when they may begin to show signs of autism spectrum disorder (not responding to their name, oversensitive to noise).
No.2: It is not “safer” to space out the vaccines. The CDC recommended schedule is based on disease risks, vaccine effectiveness at certain ages and vaccine interactions with each other.
No. 3: Vaccines do not contain harmful chemicals. Some substances contained in some vaccines do sound harmful, notably formaldehyde and mercury. The former is naturally produced in our bodies and the trace in vaccines is far less. The ethylmercury used in flu vaccines is safe and much different than the toxic methylmercury which most of us should be worried about.
No. 4: You cannot rely on everyone else’s immunity/vaccination to protect your unvaccinated children. If an outbreak occurs, unvaccinated children are far more likely to get sick.
If your definition of socialized medicine means government controlled or paid for medical care, then we are almost halfway there. Within the next few years, the government’s share of healthcare spending will approach 50 percent, according to The Centers for Medicare and Medicaid. Aging baby boomers entering Medicare will drive this. By 2027, CMS estimates about 74 million people will have Medicare and about 83 million will be covered by Medicaid for a combined total of 157 million which will be about 45 percent of the projected population of 350 million in 2027. When you add in those insured/covered by federal employee insurance, Tri-Care (military), the VA and the Bureau of Indian Affairs, the government pays for over half of us. The “Medicare for All” movement would slowly transition the other 50 percent, typically by age, into a single payer system, eventually eliminating commercial insurance. Most physicians now very cautiously back a single payer system because most commercial insurers are paying Medicare-based rates, so a single payer would just be easier for them to manage. The American Medical Association’s legitimate concern is once there is a single payer, they are at the mercy of the single payer. Seventy percent of Americans favor universal healthcare, but few are sure how it would work or be paid for. Of course, taxes would go up if the entire cost of universal care is paid for through taxes. But what hasn’t been considered in proposals is, what happens to the amount of care paid for by employers? Will they keep it and then pass the savings along to their employees in higher wages, which would then ameliorate the increased payroll taxes? Or will they continue to pay a percentage of the premium to the single payer? On average, employers cover about 67 percent of the employee’s health insurance.
Rural Hospital Jeopardy
One in five rural hospitals in the U.S. is at risk of closing unless there is direct fiscal relief or they affiliate with a larger, healthier system. Sixty-five percent of the rural hospitals at risk are considered essential because of their trauma status, services to vulnerable populations, isolation and economic impact on the surrounding communities. The states with the most at-risk rural hospitals are: Mississippi, 31 hospitals; Kansas, 29: Montana, 12; and Texas, 12. Ninety rural hospitals have closed since 2010. Left alone, most rural hospitals will close because of poor finances or their ability to attract and retain physicians. Ironically, telemedicine could hasten closures as rural populations get increased access to physicians in urban areas.
More MDs Employed
As of a year ago, 44 percent of practicing physicians were employed by hospitals or health systems. Just seven years ago, only 25 percent of physicians were employed. Over the last two years, hospitals acquired 8,000 more practices and another 14,000 physicians left private practice to become employed, according to the Physicians Advocacy Institute. In the last seven years, hospital-owned practices more than doubled from 36,700 to more than 80,000. The vast majority of physicians completing their residencies will bypass private practice and seek employment. The hassle/risk of running a private practice has become overwhelming and unfulfilling for many physicians. Physician employment is actually encouraged/driven by payment policies that favor integrated health systems where physicians and hospitals work in coordinated and managed unison to improve population health.
Your medical record
Many hospitals and physician offices are still providing only paper copies of records to their patients. Because paper copies are labor intensive, you can be charged per page. It can get expensive, especially if a hospital record. HIPAA regulations state you are entitled to a digital copy of your record if the provider has the capability to do so. In response to complaints from consumers about providers blocking/impeding electronic access to their data, the Department of Health and Human services recently made public several rules that would allow consumers easier access to their record via the app of their choice, like a smartphone, at no additional cost. The healthcare industry has been slow to adapt to available technology. In fairness, providers cannot simply raise prices to pay for their investment in information technology because their reimbursement from their party payers is fixed.
Unaware of what a procedure costs, consumers inadvertently can drive up their own premiums by unwittingly using more expensive providers. For example, your insurance benefit summary says you have a $50 copay for an outpatient MRI. So, no matter where you go for the MRI, all you know is you owe $50, regardless of the cost. Your insurance company has different payment schedules per MRI provider. It often depends on the negotiating power of the MRI provider. Larger hospital / health systems can demand higher reimbursement than smaller facilities and private physicians. By inadvertently getting your MRI done where the insurer has to pay more, you increase the expense to the insurer which causes your premium to go up. In the cases where you have a 20 percent copay, you still don’t know the overall cost and may be going to the highest price facility.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at firstname.lastname@example.org.