I’m a doctorgreedy medicine failed his father

At 2am, I heard a monotonous beep indicating that the IV pump was blocked. I was waiting with my father in the emergency department of the hospital where I work. My father had a history of metastatic prostate cancer and he had bloody stools and abdominal pain for 48 hours. Previously, his mother had sent him to another closed-door hospital. He waited alone for six hours with no vital signs taken or tests. Although he remained symptomatic, he went home.

A recent study found that in some hospitals, up to 10% of patients left the emergency room without seeing a doctor. This is likely to occur in hospitals receiving low-income patients on Medicaid. And as continuous coverage comes to an end, millions of Americans will lose the Medicaid coverage they had during the COVID-19 pandemic. Mission hospitals and clinics that serve communities will be exposed to additional strain.

The hospital where my father waited for six hours outsources emergency medical staff to a private equity-owned medical company. The company has a history of understaffing emergency rooms and maximizing revenue. This is happening all over the United States as the health care system continues to cut costs and benefits. Medicaid coverage is now ending, leaving millions of people uninsured.

The Families First Coronavirus Response Act allows families and individuals in need to continue their Medicaid coverage without having to requalify. This came in handy during the pandemic when millions of Americans lost their jobs and insurance. Medicaid coverage has skyrocketed, with more than 93 million Americans on Medicaid, compared to her 63 million Medicare subscribers. Fifteen million people are expected to lose Medicaid coverage in the next year, adding to the stress on an already overburdened system.

The hospital is already feeling the burn. Last year, the Atlanta Medical Center in Atlanta closed, making Grady Memorial Hospital the only Level 1 trauma center in Atlanta. Philadelphia’s Hahnemann Hospital closed after its parent company, the for-profit Tenet Healthcare, deemed it financially infeasible.

There’s a reason the United States ranks last among the nations for access to care. US healthcare spending in 2021 was $4.3 trillion, accounting for 18% of gross domestic product. Private equity and venture capital have invested billions in the health system. But more than 100 million Americans have medical debt.

wall street journal He recently compared New York’s administration to Florida and criticized New York’s huge Medicaid budget. But Florida’s uninsured rate is twice as high as New York’s.After all, a smaller Medicaid budget means a higher personal burden, leading to an astronomical amount of health care debt in the United States.

Uninsured people do not have access to Medicaid, and uninsured people avoid medical care, resulting in poor health. As Don Berwick, former administrator of the Centers for Medicare and Medicaid Services, writes, greed and mismatched incentives are harming patients and our health.

The truth is that healthcare is a big business and the main goal is not necessarily the best patient outcome. We will continue to see this healthcare system play out until the most important incentives—improved quality of life, health outcomes, life expectancy and profits—align.

I could see the hospital waiting room.John Cherry/Getty Images

One solution that could help millions of Americans is ending Medicaid “churning” pending during the pandemic. This refers to the temporary loss of Medicaid coverage while eligibility is being determined. This is the process of deenrolling millions of eligible Medicaid recipients due to administrative errors and paperwork. Incorrect address or contact information, as well as a change of job or employment (especially if you have a job without a fixed salary) will lead to loss of coverage. The recent increase in Medicaid coverage after 2020 is partly due to the temporary suspension of administrative disruption.

Another solution would be to expand Medicaid coverage in the 10 previously denied states. North Carolina recently expanded its program after years of debate. Expanding Medicaid eligibility will help pay for these struggling hospitals, especially those in rural areas, and help ease the financial burden on states. In addition, this expansion will help reduce medical debt. Even though 90 percent of Medicaid expansion would be funded by the federal government, these states continue to reject it, largely for political reasons.

When my father was finally seen at another hospital (where I worked and was able to wait with him), he underwent abdominal imaging and was diagnosed with diverticulitis. He came home with an antibiotic drip and within hours he felt better. What if he had stayed in another hospital waiting to be seen? It’s time for a change. The more we accept an arrangement that prioritizes profits and financial incentives in the healthcare system, the more people will suffer because the few in power make extra money.

Joshua A. Budhu, MD, MS, MPH is a neuro-oncologist at Memorial Sloan Kettering in New York and a Public Voices Fellow at AcademyHealth in partnership with TheOpEd project.

The views expressed in this article are those of the author.

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