If anyone out there was not already fully aware of the conundrum presented by our national health care system, a series of stories in The Times over the past five days should have made it clear that medical care as a whole is in a state of financial chaos that entangles private citizens, insurance companies, providers and government agencies in a web of confusion, frustration and sometimes heartbreak.
On the one hand we have access to some of the finest health care options in the world; on the other, the manner by which we pay for those options has morphed into a bleak miasma of confusion.
When the federal Patient Protection and Affordable Care Act, better known as Obamacare, was approved in 2010, many of its critics said that it was “designed to fail,” and that the intent was to so muddy the waters as to make government provided health care for all inevitable.
The Times editorial board
- Norman Baggs, general manager
- Shannon Casas, editor in chief
- Cheryl Brown
- David George
- Mandy Harris
- Brent Hoffman
- J.C. Smith
- Tom Vivelo
Five years after most of the major elements of the ACA went into effect, those predictions seem increasingly prophetic. We can’t just blame the original ACA, however, as court rulings and political maneuverings since the passage of the ACA have deformed what was initially a bad idea into a blending of government intervention and private sector manipulations that is hideous in theory and hopeless in action.
A few tidbits and observations from our stories of the past five days:
In FY 2018, the Northeast Georgia Health System provided some $64 million in indigent care services between its two hospitals in Gainesville and Braselton, reflecting an increase of 33% in the three year period FY 2016-2018. The cost of providing that service has to be recouped from somewhere, meaning those who do not qualify for indigent care foot the bill.
Despite ongoing efforts to force transparency in medical billing, patients frequently find it virtually impossible to know what services are going to cost, how much of that cost will be covered by insurance, and what to expect for actual out-of-pocket expenses. In some cases, providers don’t really know who is going to pay for what either.
Despite efforts to gain insurance coverage for everyone, a 2019 Needs Analysis of the Hall County region showed 14% of residents as uninsured. Statewide, the number is 17%.
The shakeout in the world of health insurance in recent years has resulted in only five major companies dominating the space, and much of what happens in terms of medical care is driven not by personal preference but by business relationships between providers and one of those five companies.
The insurance network that includes your personal doctor may not include your hospital; if your hospital is in network, the contracted emergency room may not be. If your employer offers insurance that’s not in a contract with local medical providers, you may have to switch to providers somewhere else. And whatever the situation this year, it may change next year.
The financial impact of medical care frequently is not something the average man or woman can afford, often resulting in personal and family hardships far beyond any physical ailments.
Everybody agrees the problem is big. Nobody really knows how to fix it.
“Any other industry that operated like this would be shut down,” Lt. Gov. Geoff Duncan said last month.
Except this isn’t any other industry. It’s the doctor who is trying to help you beat cancer; the technician doing an MRI of your brain; the emergency room where your teenager needs help after a car crash. It’s life or death played out against a backdrop of dollars and cents.
At the annual Eggs and Issues pre-legislative breakfast hosted by the Greater Hall Chamber of Commerce on Thursday, state Sen. John Wilkinson made the point that for many people the cost of health insurance has become their largest household expense, surpassing the family mortgage. And even with the best and most expensive of insurance, there’s still no guarantee the cost of treatment will be covered.
In truth, there are so many elements to the health care dilemma as to make it virtually impossible to tackle. Individual pieces of the puzzle are being worked on in many arenas, but there is no broad, sweeping fix on the horizon.
Among the initiatives, the state has proposed Medicaid waivers that would increase the number eligible for coverage, though still leave many uncovered. Lawmakers have worked for the past couple of years on making costs more transparent, and are almost certain to do so again when the legislature convenes next month for its 2020 session. There are ongoing efforts to use technology to get medical care to areas of the state where it may not exist.
Earnest work is being done on many fronts, and yet the sort of total overhaul that seems to be necessary to keep health care options exceptional while making them affordable and consumer friendly doesn’t seem to be forthcoming from any direction any time soon.
It’s a national problem and a state problem and a local problem and a personal problem, and it’s hard not to believe that government efforts to address the issue over the past decade have made things worse instead of better.
In Georgia, we are convinced that a special session of the General Assembly devoted to nothing other than health care issues is needed. We’ve had special sessions on less important issues, and it doesn’t seem we can depend on solutions from Washington, where partisan bickering and one-upmanship have made it impossible to find solutions to complex problems.
Hospitals are closing, doctors are getting out of the business, communities are without medical providers, and insurance companies are dictating medical care instead of professional providers. The majority of those covered by health insurance are dependent on their employers to decide which company will provide their coverage, and many employers who have helped foot the bill for coverage in the past find themselves stretched to the limit as costs continue to rise.
The crisis is obvious. The solution is not.