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【社会人文】专家建议全民医保
Experts tout universal care
Schwarzenegger's state health plan is considered beneficial, but skeptics remain.
By COURTNEY PERKES and BLYTHE BERNHARD
The Orange County Register
As state legislators ponder costs and other questions raised by Gov. Arnold Schwarzenegger's bid to reinvent California's health care system, experts say the plan would mean better public health and, perhaps, an improvement in sectors of society as well.
At the heart of the $12 billion proposal is requiring health insurance for the 6.5 million residents who lack coverage. Funding would come from employers, doctors and hospitals, and uninsured patients themselves.
Though much attention last week centered on the idea of insuring illegal immigrants, data show that roughly one in three uninsured Californians is a young adult like Brian Jost, a 31-year-old project engineer for a landscaping developer.
Normally healthy, Jost of Tustin recently experienced the downside of living without insurance.
In August, he returned from a trip to South America with a serious intestinal bug. He drove to four clinics across the county before finding a doctor who would see him. He passed out in the waiting room. After some medication and lab work, Jost was made well. But he was also out about $500 in savings.
He wishes he had had insurance. Nevertheless, Jost doesn't think it's the state's role to make that choice for people, or to force others to pay for it.
"I'd rather be able to pay for rent or car insurance over something that's not immediate," said Jost, a college graduate who is waiting for health coverage to kick in with a new employer. "I would want the liberty to say no."
While the debate over universal coverage will continue, experts say there's no question that insurance for all would result in an overall improvement in public health.
The Institute of Medicine estimates that at least 18,000 Americans die prematurely each year because they lack health insurance. Surveys indicate uninsured Americans are much more likely than those with health coverage to postpone seeking care or skip filling a prescription.
Public health officials say universal insurance coverage would initially drive up disease rates, because more people would be screened for illnesses like breast and colon cancer.
But earlier disease detection generally reduces death rates. And, in the long term, it's likely that disease rates would fall and emergency rooms would become less crowded as more people received immunizations and other preventive care.
Universal insurance in California might affect the community in ways that seemingly have little connection to public health.
A study by the nonpartisan Rand Corp. released in September found that California children who were signed up for Healthy Families, the state's low-cost insurance plan, did better in school.
The benefits could even result in lower crime rates, if people are getting necessary mental health treatment.
"You'll see the economic well-being of communities improve," said Georges Benjamin, executive director of the American Public Health Association.
A lack of health insurance also reduces economic productivity. Illness and medical bills contribute to up to half of all bankruptcy filings, a Harvard study found.
"If people have health coverage that allows them to see a doctor and have the tests they need, there's a savings to the system," said Dr. Richard Frankenstein, a Garden Grove pulmonologist and president-elect of the California Medical Association. "They're back to work or to taking care of the kids."
Frankenstein said he still has questions about the financial assumptions in the governor's plan. And he opposes taxing doctors 2 percent of their earnings.
"If instead of paying $10 or $20 as a co-pay you have to pay $50, that's a barrier when you're coming in for routine care that might prevent a situation from deteriorating many years later," he said. "That's hard to convince people of when they're struggling."
The governor's plan would help already-insured families by reducing their responsibility for the uninsured, officials said.
"Middle-class Californians who are insured are paying a 17 percent hidden tax on their premiums ... to compensate for the costs of the uninsured and the underinsured," said Kim Belshè, secretary of the California Health and Human Services Agency. "The governor believes that by creating a more functional health care system ... doctors and hospitals no longer will need to shift costs to insured Californians."
Local hospital officials said they were grateful the governor is tackling health care issues. But some also expressed concern about the potential costs laid out for hospitals and doctors.
"I'm not sure I quite understand the logic of taxing doctors and taxing hospitals that have for many, many years (been) and will continue to be the providers, taking care of indigent patients and shouldering those societal burdens," said Jon Gilwee, senior director of government health care programs at UC Irvine Medical Center.
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作者:admin@医学,生命科学 2011-03-04 05:11
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