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Perhaps Senator Richard Shelby (R-AL) might want to explain to the Southern Nevada Mental Health Coalition how increasing access to health care in this country is going to destroy the “best health care system the world has ever known?” The Las Vegas Sun reports 117 people in Las Vegas area emergency rooms waiting for psychiatric help, a number higher than when Clark County officials declared a mental health emergency back in 2004.
If we had the “best health care system the world has ever known,” then why couldn't $13 million be found (or created) in the state budget for a triage center where “patients could get physical and psychiatric evaluations in the same place?” If we have “the best health care system the world has ever known” then why are we warehousing mental patients in 15 Las Vegas area hospitals?
If we have the “best health care system the world has ever known,” then why are at least 468,808 Nevada citizens uninsured; why do almost one in five Nevadans have no access to this marvelous system without resorting to using the services of the ER? Why are approximately 150,717 adult women in Nevada without health insurance? Why are some $257,300 men in Nevada not covered by some form of health care insurance?
If we have the “best health care system the world has ever known,” then why are 21.9% of the men in this country uninsured? Why are 17.7% of the non-elderly women in the country not insured? Why are 28.5% of expectant mothers in Nevada going without pre-natal care? Why are 20% of the toddlers in this country not given the five basic immunizations? Why are only 67% of the little ones getting vaccinated in Nevada?
If we have the “best health care system the world has ever known,” why did one 2007 study of four teaching hospitals find one in which a 10% increase in occupancy led to a 15% increase in “adverse events,” suggesting that consistently high workloads, where patient to nurse ratios may increase, pose a risk to patient safety? Why did another recent study confirm that “lower nurse staffing and extended shifts are associated with self-reported errors and increased mortality?” Worse still, why have we known about these factors since 1993 and have done little to improve the situation? We've known for years that low staff levels correlate to “adverse outcomes,” that pneumonia rates are especially sensitive to staffing levels, and that there are indications of a direct relationship between staffing levels and mortality but, wait, say the champions of “free-marketeering,” we have the “best health care system the world has ever known.”
Those 117 unfortunate souls waiting in Las Vegas area emergency rooms for evaluation and treatment are just the latest manifestation of a more serious problem. About two-thirds of U.S. primary care doctors reported in 2005 that they couldn't get outpatient mental health services for their patients. Why? The three most common reasons: Lack of, or inadequate, insurance coverage; health plan barriers; and shortages of mental health providers. This, in the “best health care system the world has ever known.”
In the Commonwealth Fund study, 67% of the primary care physicians reported that they could not obtain quality mental health care services for their patients; “more than double the rate for other common services including specialist consultation, nonemergency hospital admissions, and imaging services.” 59% of the doctors cited a lack of insurance coverage, or inadequate coverage, as a “very important reason” the care could not be secured. (emphasis added) One of the issues identified in a paucity of mental health services for children: “Inadequate benefit packages, in which current state laws allow insurance policies to limit access to mental health services through separate deductibles, high copays, and annual spending limits lower than those established for medical services.” This, too, in the “best health care system the world has ever known.”
The “best health care system the world has ever known” incorporates the following into its matrix: “Hospital admissions for the uninsured increased by a third between 1997 and 2006, rising from 1.7 million to 2.2 million stays, according to the Agency for Healthcare Research and Quality. The 34 percent increase is more than double the 14 percent rise in overall hospital admissions during the same period.” Included in the reasons for hospitalization: A 167% increase in skin infections; a 101% increase in unidentified chest pain; a 76% increase in diabetic complications; and a 41% increase in depression and mood disorders. Our situation gives the appearance of being one in which we have more people experiencing more medical problems with fewer resources to pay for it. And, the AHRQ reported that the bill for treating uninsured patients increased 76% from $11,000 to $19,400 per stay as compared to a 69% increase in overall hospital charges.
And, in this “best health care system the world has ever known” illness and medical bills caused 50% of the 1,458,000 personal bankruptcies filed in 2001. More than 75% of those filings came from those who had health insurance, while 38% had lost their coverage at least temporarily by the time they filed for bankruptcy. Some were caught in a Catch-22: They lost their jobs because they were sick, and because they had no job they lost their health insurance. Insurance policies with high deductibles, co-pays and many exclusions offered little protection during a serious illness. “The paradox is that the costliest health system in the world performs so poorly. We waste one-third of every health care dollar on insurance bureaucracy and profits while two million people go bankrupt annually and we leave 45 million uninsured" said Dr. Quentin Young, national coordinator of Physicians for a National Health Program.” Dr. Young's summary says it all.
What Senator Shelby ranks as the “best health care system the world has ever known” doesn't even make the World Health Organization's top ten list. The United States is ranked 37th, behind France (ranked number 1), Italy, San Marino, Andorra, Malta, Singapore, Spain, Oman, Austria, Japan, Norway, Portugal, Monaco, Greece, Iceland, Luxembourg, Netherlands, United Kingdom, Ireland, Switzerland, Belgium, Colombia, Sweden, Cyprus, Germany, Saudi Arabia, the UAE, Israel, Morocco, Canada, Finland, Australia, Chile, Denmark, Dominica, and Costa Rica.
continued>>>
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