Two of the most talked-about issues in healthcare today start with the word "access": access to healthcare services for the uninsured and access to capital. If you believe the critics who pound their chests over either one, you'd think that we need to solve these crises immediately lest we be condemned to a world in which healthcare services, if they're available at all, are reserved for the rich.
Let's add a little common-sense perspective to each issue, starting with the uninsured. Last October, the U.S. Census Bureau released its latest figures on the uninsured. The agency said 43.6 million people, or 15.2% of the population, were without private or public health insurance in 2002 (Oct. 6, 2003, p. 8). That's up from 41.2 million people, or 14.6% of the population, in 2001. Without argument, it is unfortunate that the ranks of those without healthcare insurance benefits rose, but in 2002 nearly 85% of the U.S. population, or more than 243 million people, did have private or public health insurance.
Consequently, to solve the problem of the uninsured, solutions should be targeted at those 15.2% of people without coverage. That's why President Bush's plan, outlined in his State of the Union address last week (See cover story, p. 4), is a good one. It's incremental and it targets the people who need both basic and catastrophic coverage. It would use the federal tax code to make it cheaper for people to buy health insurance. It doesn't hurt 84.8% of the population to help 15.2% of the population.
That's blasphemy to supporters of universal coverage or a national single-payer system, who use the problem of the uninsured to pursue their politically driven ideal of a healthcare utopia. It's also grating to the ears of most liberals who, while perhaps not in support of a national single-payer system, say Bush's plan is politically motivated. They charge he has no intention of pushing his access plan, which simply is a shield to deflect criticism from Democratic presidential candidates. So what? Anything-even a political maneuver in an election year-that keeps the healthcare system from adopting a single-payer system is good for patients.
For another and decidedly more whimsical commentary on access problems in America, please read an online editorial by Managing Editor Neil McLaughlin at modernhealthcare.com. Healthcare economist Uwe Reinhardt also discusses the uninsured in this week's commentary (p. 28).
Now, on to access to capital. Not a day goes by without our editorial staff hearing from an individual or group that claims access to capital is at a crisis stage, with healthcare providers unable to make or borrow enough money to adequately staff and equip their facilities to care for patients. In focus groups with readers, we often ask what concerns them most and they invariably say access to capital. Last October, the Healthcare Financial Management Association released the results of a poll of hospital executives who said their facilities' access to capital had lessened.
Then we check our e-mails and go to our mailboxes. There we find news release after news release about healthcare providers purchasing new medical or information technologies, or building replacements or entirely new facilities at costs of hundreds of millions of dollars. In our Jan. 12 issue, we reported on the first increase in the number of general acute-care hospitals in the U.S. in more than 25 years (p. 6). Sure, everyone is always worried about where their next dime will come from and it would be irresponsible of healthcare executives not to be concerned. But there's no crisis. Money is cheap and the healthcare sector of the economy is booming. And last month Congress threw another $400 billion in the pot via Medicare reform.
There are a lot of things that keep me up at night. Will the Packers hire a defensive coordinator who knows how to stop a fourth-and-26 play against the Eagles in a playoff game? Will my daughter's shoe-box-and-rubber-band guitar stay together long enough to make it to her third-period science class? But when I have trouble sleeping, I just think about our healthcare delivery system. Zzzzzzzzzz.