Given the lack of enthusiasm from the medical community for Connecticut’s experiment in health insurance for sort of, kind of poor folks, it may be time to actually explain why the docs run from the room screaming when the Charter Oak health plan raises its furry little head.
It’s not just the money, despite the tone of much of the public debate on the state’s hodgepodge program, which pretends to be real insurance, despite income transfers that look and smell quite a bit like “welfare.”
As with almost all of these “insurance” programs, both the costs and the demand for Charter Oak were underestimated, to the surprise of almost no one at all.
The hospitals and the docs whine that this program for the sort-of-poor is no better, and in some cases, even worse than the existing Medicare-Medicaid nightmare that holds down costs by slashing fees to the medical providers.
Cost Centers
Now, the hospitals and the docs are reluctant to sign on the dotted line for another avalanche of new patients who don’t enhance the bottom line.
Left unsaid in all this dancing around is that the Charter Oak patient population is identified as “working uninsured,” which is to say, there is an expectation that they will be treated, and talked about, with more respect than the great unwashed lined up at the welfare offices.
Marketers know that there are ways to deal with a surge of customer demand from folks that don’t have much money to spend. No potted plants in the office or store, no gracious sales staff to show the customers around, no artistic displays of the goods and services.
Of course, we pretend that health care doesn’t, or at least shouldn’t, work that way. In the popular imagination, there is no such thing as purposely mediocre medical care for folks who can’t pay for the very best.
Racial Disparities
There is much medical and social science literature touching on the real and imagined “racial disparities” in health outcome — presumably tied to race or income.
But there’s more going on than that. There’s a dirty little secret that almost never gets addressed out loud; a matter of health care reality so embarrassing that all the public discussion of programs such as Charter Oak focuses exclusively on reimbursement.
The other substantial impediment to medical servicing of the Charter Oak patient population is that the poor are different than you and me.
They miss their appointments, they are less articulate about their medical problems, and their level of compliance with treatment directives is spotty.
Although it would be distasteful to explain to the world what is going on in the subconscious of the doctors reluctant to service Charter Oak patients, in fact, lower-income patients are less efficient to treat and less pleasant to treat — whether or not the reimbursement is sufficient.
To arm the Charter Oak patients with “insurance” is to suggest that they would wander in for treatment, not only to “community health centers” or urban clinics or emergency rooms that are experienced in caring for lower-income populations, but to suburban and other more snobby venues where the staff may lack what is delicately referred to as “cultural competency.”
There is very little in the retail or professional services world that pretends to be all things to all people. We expect that of health care, even if we know better.
To be sure, a big bag of gold thrown at the medical community would ease most of the angst about treating the Charter Oak population. But there’s more to it — whether it gets talked about or not.
Laurence D. Cohen is a freelance writer.
