Those who study American health care point out that when patients have no family doctor, their health conditions get no overall management. That leads some to overuse emergency rooms, the most expensive place of all to get care.
As Kate Long reported in the Saturday Gazette-Mail, Charleston Area Medical Center sought data to flesh out the picture locally. The facts are eye-openers:
* The 36 most frequent users of CAMC's three emergency rooms made 978 visits in six months - an average of 27 apiece. Each visit costs an average of $756.
* Although 32 of the 36 most "frequent fliers" had insurance, those 978 trips to the ER left CAMC holding the bag for more than $500,000 in uncompensated care.
* Twenty-nine of the 36 most frequent fliers were covered by Medicaid.
* The state apparently has about 400,000 Medicaid patients, but nobody monitors the care of about half of them. "If they come to the ER 50 times in six months, nobody follows up to see what the problem is. They're on their own, but Medicaid pays the bills," Long wrote.
Management can improve health care and cut costs.
When Medicaid, a program funded partly by federal taxpayers and partly by state taxpayers, has paid clinics to manage patients' care, it has cut overuse of ERs. West Virginia Health Right's management of uninsured patients cuts the overuse of ERs as well.
All this is encouraging. Americans can learn to manage health care and its costs better. Necessity is the mother of invention.
But Americans will also have to talk about one of the drivers of these costs - the fact that government programs promise care, but don't pay doctors and hospitals enough to cover the costs of providing it.
Medicare's reimbursement rate is so inadequate that some practitioners won't take new Medicare patients. Medicaid's reimbursement rate is even worse, so many doctors won't take those patients either.
Doc-in-a-box clinics, for example, could at least screen patients, but most won't accept Medicaid because of its low reimbursement rate. Would improving reimbursement rates for clinics help steer people away from seeking care at much more expensive ERs?
The goal of health care reform efforts is to "bend the health care cost curve."
But if the costs of the programs that drive the spiral are vastly understated to begin with, it's hard to see them going down if the programs cover more people.