Health Insurance NOT the Same As Access to Health Care

Most of the Left wants to measure access to health care by the percentage of people who have health insurance, implying that those without insurance have no access to care.  But in fact the uninsured in the US have access to better health care than most other people in the world.

And it will soon become apparent that the converse is not true either - even with insurance, in a top-down rules-driven government-controlled health care system, one may not have access to health care.    For example, one of my employees was complaining that she was having trouble with workers comp getting care for her injury.  This is a follow-up email I received today from my insurance agent (redacted only for privacy issues):

I talked to [valued employee of my company, call her Jane] this morning regarding her lack of attention from [our workers comp insurer].

I then followed up immediately with [representative of workers comp insurer] working on her account, in Sacramento, CA.

It seems the problem is her injury occurred in CA and she's now in MO.  The doctors in MO don't want to see her due to the paperwork and issues required under the CA laws. 

Jane advises she gets relief from going to a chiropractor.  I told her to keep going and I would get [insurance company] to approve those visits, which [workers comp insurer rep] said she would.

So, it comes down to [our insurance company] trying to find an Orthopedic Doctor who will take her and comply with the CA requirements, which the Drs. don't like.

There is no issues on coverage, it's a political issue.

Already, Medicare and Medicaid patients have trouble finding doctors to treat them.  Enjoy the cozy feeling of being "insured" via Obamacare.  Let's hope that when you are sick, there is a doctor who will see you.


  1. norse:

    For a lot of great background on why US healthcare is so expensive, complicated and suboptimal in outcomes, have a read at one doctors very frustrated but detailled opions: (note that the links in the text are broken, but the header menu up top works to take you to the individual articles, no need to watch the videos)

  2. sean2829:

    I think this issue is minor compared to the other problem related to care. The average household expense for healthcare is now over $20K per year while the medium income is $50K per year. Of the $20K expense, $10-11K is likely paid by an employer for health insurance premiums, ~$4K+ is paid by the employee for health insurance premiums and another $5K is spent out of pocket. Think about a two earner family, each making $12 an hour. Even if they have health insurance, will they be able to afford the out of pocket expenses to see a doctor? It shocks people who have received Medicaid while on public assistance how much money they have to pay out of pocket for health care when they get a job with healthcare benefits.

  3. LarryGross:

    re: access to health care. Indeed.. Everyone does. Just wait until your disease is advanced and very expensive to treat and show up at the Emergency Room and receive all the uncompensated health care you wish to consume - and the costs will be shifted to those who have insurance - and taxpayers (hospitals are reimbursed for uncompensated care costs).

    so the real question is how do you want to pay.

    I've seen estimates that as much as $1000 a year is added to private insurance costs per person to pay for the uncompensated ER care for those who are uninsured.

    if we could cut that cost in half by providing earlier intervention treatment..we'd oppose paying less ?

  4. nehemiah:

    Larry, you just don't get it or you refuse the point. It isn't about cost of service or cost of coverage for that service. Warren's point and something I've been saying since the bill passed is that it will be about accessing service. Fewer and fewer doctors and nurses are going to affect access. No way around it. Great new Larry, you have insurance. The bad news Larry, there is nowhere to obtain service when you need it.

  5. LarryGross:

    don't we all agree that the uninsured get access to service right now? no? yes? My impression is that they get access to service but that service is ungodly expensive.

  6. nehemiah:

    What is your point. I will grant you that taking aspirins in the emergency room is tremendously inefficient, but when we start losing doctors who refuse to stay in the profession because of continuing malpractice exposure with lower income per transaction those patients will be back in the emergency room to get their aspirins because they won't be able to see a GP or specialist.

  7. David:

    There is an older, less-affluent gentleman in my community (Washington DC) whom I guided through the process of finding a doctor. It took nearly a year to get him an appointment with a primary care doctor who took medicare. Many, many doctors here now take no insurance at all, and this phenomenon is increasing as physicians opt out entirely. We have the worst of all worlds from a regulatory standpoint (well, no, it can always get worse... but our environment has the disadvantages of a highly socialized system without the advantages). Bleah.

  8. mesaeconoguy:

    Wrong, idiot, the question is who should pay?

    Using government to “solve” inefficiencies (caused by government) is the worst possible option. And using
    a horrifically, poorly written piece of shit legislative sledgehammer (passed against majority will in the dead of night) to do it is about the worst thing you can do.

    Obamascare literally is destroying the economy (along with idiotic hyperregulation), and will likely result in doctor/medical service relocation outside the US, and violence.

  9. mesaeconoguy:

    No we don't agree, moron, you will find that using government to provide “access” (see above – it won’t) to those currently lacking access is wildly more expensive and inefficient than either the current system, or other solutions.

    In 5 years, the health insurance industry/market will be radically warped, and healthcare delivery will be dramatically changed for the worse.

  10. LarryGross:

    I guess my point is that if people already can go to ERs to get their care - doesn't that mean we have way more ER doctors and nurses and that over time if people shift to primary care from ER that we'll need less ER docs and more Primary Care docs.

    but the real point is that you and I already are paying for this and the way we are paying is that we are paying for ER docs rather than primary care docs.

    I think the only way to get govt out of it is to not provide free ER care and not provide MedicAid either... then we'd not be paying those costs.

    If we need more primary care docs then just pay them an extra stipend when they go to Medicare School.. or similar incentives... we're probably going to see an increase in Physician assistants and Nurse Practitioners if the reimbursement rate is not advantageous to docs.. But even lower level providers can perform much of the basic screening and related work anyhow.

    My Primary Care physician currently is in a practice with a Physician Assistant and the Assistant handles the lower-level cases and elevates them to the Primary care when needed.

    it seems to work...

  11. Nathan:

    I can't resist posting my own stories of obtaining health care, with and without insurance. It's anecdotal, to be sure, but I don't think it's unusual.

    A few years ago, while attending a conference in Malaysia, I developed a sore throat that I was fairly sure was an infection, as I'm prone to them while traveling. I went to the hotel concierge at noon on Sunday and asked if there was any chance I could see a doctor that day, as I was leaving Monday morning and traveling all day, so if I didn't see a doctor immediately, I'd have to suffer two more days at least. She told me that there was a clinic nearby, which she proceeded to call to ensure that they were in fact open. I asked how late they were open, as the conference ended at 4:30. She gave me an odd look, and told me that she had just made an appointment for me, and that I could go on my lunch break, which lasted until 1:30. I was somewhat skeptical, but proceeded to hail a taxi, which drove me to the clinic in about ten minutes. The cabbie told me that cabs didn't come by the clinic very often, so if I wanted, he'd just wait outside so he could drive me back to the hotel. I felt like I had walked into some sort of alternative reality, but reluctantly agreed. I walked into the clinic, where the receptionist/nurse took me immediately to the doctor (no wait at all!). The doctor (who spoke fluent English) looked in my throat, diagnosed the infection, and prescribed me three medications, which the nurse then game me a few minutes later. No need to go to a pharmacy; no five pages of paperwork; no insurance billing information. The total cost for a last-minute, Sunday-afternoon appointment with an English speaking doctor, plus a week's worth of three different meds, was $17. Plus $10 for the round-trip cab fare. I made it back to the hotel before 1:00.

    In case you're thinking that it was so cheap because Malaysia is a third-world cesspit, I'll point out that Malaysia is a rapidly growing economy with a per capita GDP of around $17,000/yr, which makes it poorer than the U.S., but on the same level as some Eastern European countries and only slightly less than poorer Western European countries like Portugal or Greece. Even if you triple the cost to account for the income difference, it's still a very reasonable $50.

    By contrast, here in the good old U.S. of A, I have insurance. But getting a same-day or even same-week doctor's appointment is nearly impossible; forget about on Sunday! The co-pay for an office visit is $30 dollars, and the co-pay for medications is at least $15, and sometimes much higher. Even when you do get an appointment, the doctor is routinely running hours behind schedule. (The last two doctors I've been to have each been over two hours late). Now, I'm sure if you have cancer or some chronic condition, being insured in the U.S. is better than paying out of pocket in Malaysia. But for routine medical issues, I'll take Malaysia's system over America's any day.

  12. LarryGross:

    thanks for sharing! Wiki says Malaysia is a dual govt/private system of universal health care. Do you know if the clinic was govt run or not?

  13. MD.Asifur Rahman:

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