After finding myself with a serious and very painful infection and no medical services available in my community, I decided to find out what was wrong. When I moved to this island, we had two thousand year-round residents and another fifteen hundred summer people. We also had four doctors. We had lab facilities and minor surgery capability. We now have ten-thousand year-round residents and two doctors working at a clinic that can’t make ends meet. What happened?
As for the clinic, I couldn’t understand why it suddenly stopped making enough money to survive, so I attended a community meeting about health care on our island. The clinic administration sent a couple representatives to talk to us. The representatives agreed that the clinic was at capacity with only two doctors. They also said their goal is to provide primary care rather than stitching up minor cuts. If we cut a finger or a child falls off their bike and scrapes a knee, they are expected to go to an urgent care center off island. Because of ferry schedules, it can take up to two hours to get to an urgent care center. Old people with the flu are expected to ride the ferry to get their Tamiflu prescription. If you have an ear infection, strep throat, broken bone, or pneumonia, take the ferry off island.
One representative had a graph showing sources of income for the clinic. It didn’t look right to me. He had a pale green section for grants. City of Seattle gives clinics inside the city grants. We don’t qualify. They had a purple bar for Medicaid income and a blue bar for Medicare income. The orange bar for income from private insurance was tiny. That just couldn’t be right. Everybody, on the island young enough to work, has health insurance.
I raised my hand. “Why aren’t you bringing in more from private insurance.”
The rep answered, “They only pay about a third of what it costs us to see a patient, while Medicaid pays one hundred percent and Medicare pays about sixty percent.”
I didn’t believe him. Surely, that expensive health insurance we buy actually pays our doctors for the services we receive. Didn’t the ACA specify that insurers have to pay eighty percent of their proceeds in claims? Okay, having worked with human services agencies I know twenty-percent overhead and profit is outrageously high and can be manipulated by how you define services.
I went to the internet and started looking for articles on who pays what. After reading several articles I came to the conclusion that I was wrong and the clinic representative was correct. Health insurance companies make up their own schedule of what they are going to pay, and a doctor’s office or clinic receives a portion of what they allow. In most of the cases I read about, insurance companies pay about a third of what it costs to see a patient.
I’ve found rumors that big systems like Swedish in Seattle can negotiate with insurers to get a better level of reimbursement. They have a huge base. If someone wants to sell health insurance in Western Washington that policy must cover the Swedish system along with the University of Washington system. Everybody uses those systems for backup on complicated issues.
So with only thirty percent of their costs reimbursed by insurance, how can a clinic survive? As I mentioned, they get some government grants—read: our tax dollars. Both Medicare and Medicaid reimburse at an acceptable rate so Medicaid patients are sought after to offset the deficits cause by private insurance—read: our tax dollars.
My community doesn’t have enough Medicaid and Medicare patients to offset the costs not reimbursed by private insurance.
I have some serious ethical concerns about the funds people with disabilities bring into a system being used to offset the costs of healthy, wealthy people. The practice smacks of prostitution.
My youngest foster daughter who has multiple disabilities lives in the city now. I had wondered why she has such attentive doctors. She has appointments every six weeks. Sometimes she’ll see more than one practitioner at once. She is over medicated, and some of her chronic conditions never get better. Once, I got her a cream at the health food store for a rash. It cleared that rash right up. The doctors told her not to ever use it again. The rash is back, but she’s afraid to use her herbal cream. We can’t have this little source of income for the clinic get well.
So, we have clinics that are not sustainable without an influx of tax dollars to support those people who buy insurance through their work or the exchanges. We have clinics who use Medicaid patients to supplement their income. Because clinics and private practices are not sustainable, we have trouble hiring enough professionals to serve communities outside the big population hubs where clinics can attract more Medicaid patients to exploit.
What do people in rural or isolated communities do? On Vashon, we are exploring our options. Some people have suggested a medical tax district to subsidize patients who have health insurance—more tax dollars. Some people have looked at the system and said, “This is almost socialized medicine. Why not go all the way?” The eventual ethical solution to the problem is a national single payer system, but that is not likely to happen before I get sick again, despite the fact that it would be cheaper for the general population and is almost what we have now.
Curiously, one of our biggest road blocks to a single payer system is the person who buys insurance through their job then says, “Why should I have to pay taxes so that some person who doesn’t work can have health care?”
The real question is, “Why should someone with disabilities have to run to the doctor every six weeks and take more medications than they need or is good for them, so that you can have health care?”
In the meantime what can isolated communities do to attract medical professionals? We must be able to pay for our care. Before the ACA, Washington State had a program called Basic Health. It was funded through our tax dollars along with a sliding scale fee for those who qualified by being too poor to buy corporate health insurance. My proposal would be to resurrect that program with a few modifications. Basic Health would be funded by those people, who qualified to purchase their health care through the program, because they live in an area with inadequate health care services. The coverage could be purchased at the market rate for private coverage. The big difference between the state sponsored program and corporate health insurance companies is that providers would be reimbursed for what they bill or at least at the same rate as Medicaid pays. This program would need reverses that would need funding through Federal Grants until it could build reserves through premiums.
Until we can find some way to fully fund health care, many of us will go without healthcare despite paying for it. Some people will continue to be exploited for the dollars they bring into a system, and some people will continue to profit off of a broken system.
As for the clinic, I couldn’t understand why it suddenly stopped making enough money to survive, so I attended a community meeting about health care on our island. The clinic administration sent a couple representatives to talk to us. The representatives agreed that the clinic was at capacity with only two doctors. They also said their goal is to provide primary care rather than stitching up minor cuts. If we cut a finger or a child falls off their bike and scrapes a knee, they are expected to go to an urgent care center off island. Because of ferry schedules, it can take up to two hours to get to an urgent care center. Old people with the flu are expected to ride the ferry to get their Tamiflu prescription. If you have an ear infection, strep throat, broken bone, or pneumonia, take the ferry off island.
One representative had a graph showing sources of income for the clinic. It didn’t look right to me. He had a pale green section for grants. City of Seattle gives clinics inside the city grants. We don’t qualify. They had a purple bar for Medicaid income and a blue bar for Medicare income. The orange bar for income from private insurance was tiny. That just couldn’t be right. Everybody, on the island young enough to work, has health insurance.
I raised my hand. “Why aren’t you bringing in more from private insurance.”
The rep answered, “They only pay about a third of what it costs us to see a patient, while Medicaid pays one hundred percent and Medicare pays about sixty percent.”
I didn’t believe him. Surely, that expensive health insurance we buy actually pays our doctors for the services we receive. Didn’t the ACA specify that insurers have to pay eighty percent of their proceeds in claims? Okay, having worked with human services agencies I know twenty-percent overhead and profit is outrageously high and can be manipulated by how you define services.
I went to the internet and started looking for articles on who pays what. After reading several articles I came to the conclusion that I was wrong and the clinic representative was correct. Health insurance companies make up their own schedule of what they are going to pay, and a doctor’s office or clinic receives a portion of what they allow. In most of the cases I read about, insurance companies pay about a third of what it costs to see a patient.
I’ve found rumors that big systems like Swedish in Seattle can negotiate with insurers to get a better level of reimbursement. They have a huge base. If someone wants to sell health insurance in Western Washington that policy must cover the Swedish system along with the University of Washington system. Everybody uses those systems for backup on complicated issues.
So with only thirty percent of their costs reimbursed by insurance, how can a clinic survive? As I mentioned, they get some government grants—read: our tax dollars. Both Medicare and Medicaid reimburse at an acceptable rate so Medicaid patients are sought after to offset the deficits cause by private insurance—read: our tax dollars.
My community doesn’t have enough Medicaid and Medicare patients to offset the costs not reimbursed by private insurance.
I have some serious ethical concerns about the funds people with disabilities bring into a system being used to offset the costs of healthy, wealthy people. The practice smacks of prostitution.
My youngest foster daughter who has multiple disabilities lives in the city now. I had wondered why she has such attentive doctors. She has appointments every six weeks. Sometimes she’ll see more than one practitioner at once. She is over medicated, and some of her chronic conditions never get better. Once, I got her a cream at the health food store for a rash. It cleared that rash right up. The doctors told her not to ever use it again. The rash is back, but she’s afraid to use her herbal cream. We can’t have this little source of income for the clinic get well.
So, we have clinics that are not sustainable without an influx of tax dollars to support those people who buy insurance through their work or the exchanges. We have clinics who use Medicaid patients to supplement their income. Because clinics and private practices are not sustainable, we have trouble hiring enough professionals to serve communities outside the big population hubs where clinics can attract more Medicaid patients to exploit.
What do people in rural or isolated communities do? On Vashon, we are exploring our options. Some people have suggested a medical tax district to subsidize patients who have health insurance—more tax dollars. Some people have looked at the system and said, “This is almost socialized medicine. Why not go all the way?” The eventual ethical solution to the problem is a national single payer system, but that is not likely to happen before I get sick again, despite the fact that it would be cheaper for the general population and is almost what we have now.
Curiously, one of our biggest road blocks to a single payer system is the person who buys insurance through their job then says, “Why should I have to pay taxes so that some person who doesn’t work can have health care?”
The real question is, “Why should someone with disabilities have to run to the doctor every six weeks and take more medications than they need or is good for them, so that you can have health care?”
In the meantime what can isolated communities do to attract medical professionals? We must be able to pay for our care. Before the ACA, Washington State had a program called Basic Health. It was funded through our tax dollars along with a sliding scale fee for those who qualified by being too poor to buy corporate health insurance. My proposal would be to resurrect that program with a few modifications. Basic Health would be funded by those people, who qualified to purchase their health care through the program, because they live in an area with inadequate health care services. The coverage could be purchased at the market rate for private coverage. The big difference between the state sponsored program and corporate health insurance companies is that providers would be reimbursed for what they bill or at least at the same rate as Medicaid pays. This program would need reverses that would need funding through Federal Grants until it could build reserves through premiums.
Until we can find some way to fully fund health care, many of us will go without healthcare despite paying for it. Some people will continue to be exploited for the dollars they bring into a system, and some people will continue to profit off of a broken system.
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