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Socialized Medicine v. Insurance Coverage in the United States (If I was competing for the most boring title, I think this would win).

Written by: Patricia I. James**

Post #15 concerned a doctor who was engaging in balance billing, basically trying to get paid the entire amount of her bill rather than just accepting what the insurance company paid. One of the comments I received was a vote for socialized medicine. I responded to her comment and suggested she read an article in Forbes that dealt with that issue. I subsequently read back issues of the Los Angeles Times (Saturday is my day to read the week’s editions), and came across an article by Chad Terhune which addressed the fact that Anthem/Blue Cross was going to cut Cedars-Sinai (Cedars”) and UCLA from its health plan.

Now, these two issues are not at opposite ends of the spectrum. If I drew a circle (imagine a clock), I would arbitrarily put socialized medicine at 2:00 and insurance coverage at, say, 7:00. (My circle, my rules). However, they both address what type of care a patient may be able to receive.

An article entitled “The Ugly Realities Of Socialized Medicine Are Not Going Away,” by Sally Pipes, found at http://www.forbes.com/sites/sallypipes/2011/12/19/the-ugly-realities-of-socialized-medicine-are-not-going-away-3/ states that the recession has forced countries around the world to curb public spending. Ms. Pipes uses Great Britain as her prime example. The National Health Service (NHS), which is the centralized public agency that runs Britain’s government healthcare systems, has to shave off $31 billion from its budget by 2015. That’s right, $31,000,000,000 in the next three years. Wow.

Not surprisingly, this has led to a dramatic drop in the quality of care patients receive. Ya think? In order to accomplish its goal, the NHS is cutting more than 20,000 NHS jobs over the next two years, closing a number of hospitals and making it tougher to qualify for treatment. As for surgery, if it isn’t meant to save your life, you can go to the back of the line.

Whereas approximately eleven percent of Britons pay privately for their healthcare, the remaining percentage pay substantial taxes to obtain “free” health care from the government. However, this does not include cutting-edge medical treatment since the government believes that these treatments are just more expensive, not better.

So, Ms. Pipes asks, since everyone in Britain has access to health care, isn’t that better than the situation in the United States where tens of millions of people lack health insurance? She says no. Although Britain may “guarantee” access to care, it does not mean that patients actually receive the care since the NHS’ priority is to keep costs down, not to provide quality care.

Ms. Pipes uses one example of a 69-year-old farmer who had been diagnosed with a hernia over a year ago and needed an operation. The government requirements state that he is supposed to receive treatment within 18 weeks. He is still waiting.

She goes on to state that twenty percent of hospitals are failing to provide minimum care for elderly patients. When inspectors dropped by some of these hospitals unannounced, they found patients shouting or banging on bed rails trying to get the nurses’ attention. At one hospital, bed-ridden patients had not been given water in over ten hours. Not a pretty picture.

Ms. Pipes also gives a nod to Canada where they pay massive taxes to finance universal healthcare. Even so, nearly a quarter of the three thousand patients surveyed said that they had skipped their medication or did not fill a prescription because it was too expensive. Many Canadians come to the United States for care since they believe the wait in Canada is too long and harmful to their health.

As far as President Obama’s healthcare plan is concerned, Ms. Pipes opines that the United States will soon face the same sort of reckoning as Britain. However, and correct me if I am wrong, I thought that the plan required everyone to have health insurance, much like car insurance in California, not that taxes would go to a government-imposed health care system. (At least that’s what I understand from listening to Dave, Shelly and Chainsaw).

In sum, Ms. Pipes’ conclusion is that an examination of socialized medicine shows that government cannot fix the healthcare problem.

Now, on to the United States where, according to Chad Terhume of the Los Angeles Times, Anthem Blue Cross has eliminated doctors affiliated with Cedars and UCLA from their health plan that is offered to approximately “60,000 employees and dependents at the cash-strapped city of Los Angeles.” The city of Los Angeles opted for this plan because it would save $7.6 million in annual premiums next year.  The link is http://articles.latimes.com/2012/sep/21/business/la-fi-hospital-costs-20120921.

To keep this in context, only 27,000 of the city workers and their families are enrolled in Anthem and, of those, less than 10% have physicians at Cedars or UCLA. Therefore, only 2,200 city workers and family members are expected to lose access to their doctors.

Cedars and UCLA, institutions which are known to tend to the rich and famous, can no longer get by based solely on their reputation when the United States is struggling with a 2.6 trillion dollar annual healthcare bill. That would be $2,600,000,000,000. Kind of makes the $31,000,000,000 seem rather paltry, doesn’t it?

These two institutions are, not surprisingly, unhappy with this turn of events. Thomas Priselac, chief of Cedars-Sinai Medical Center, says that these exclusions offer a “false economy” since they don’t reduce costs in the healthcare system overall; “[i]t just pushes the cost onto those who continue getting care at those facilities.” Yeah, so?

Officials at Cedars also say that the healthcare provided there is more expensive because they “are tied to their world-class medical research and cutting-edge treatments in areas such as cancer or organ transplants that benefit the entire community.” (Remember Britain’s take on this: It’s not better; it’s just more expensive). Along that line, Steven Scott, general manager of groups sales for Anthem Blue Cross, stated that Cedar-Sinai’s and UCLA’s “costs are up to 50% higher than competitors and the quality of care isn’t measurably better.”

Apparently, other insurers are offering limited networks, which have fewer choices and lower-priced doctors and hospitals. This is at a time when health insurance premiums in the United States have increased three times as fast as inflation and wages over the last decade.

I know that there are many voices out there who have varying opinions on and experiences with socialized medicine and insurance coverage in the United States. I also know that some of the care that is doled out in the United States (think nursing homes) is beyond deplorable. Certainly, since our firms’ primary focus is medical malpractice, I have seen how far healthcare can miss the mark. Having said that, call me naive but I’m still going to go with the United States’ way of doing things. When it changes, I’ll reassess my opinion.

**No portion of this Post is intended to constitute legal advice. The views expressed are solely those of the author.