Michael Townes Watson

Health Care for U.S. Kids Falls Short

An article one of this week’s Business Week journal would come as no surprise if you have been following the developments in Washington about SCHIP (the program that provides medical insurance for children who lack private healthcare insurance). The article states that healthcare for kids falls far short of being even adequate. What is surprising, however, is that the article addresses the quality of care not for children in the SCHIP program, but for all children, even those with private health insurance coverage. Here is the conclusion reached by researchers:

“It seems that even white, middle-class, well-insured children get poor quality health care more often than not. A large study published in the New England Journal of Medicine found that American children receive recommended health-care procedures only 46% of the time when they see a doctor.”

Notice that the conclusions are published not by some “litigation-hungry trial lawyer” or a “wild-eyed consumer advocacy group.” These are the conclusions published in the New England Journal of Medicine, based upon the research of the RAND corporation scientists, some of the most well-respected scientific researchers in the world. Additional conclusions published are these:

1. “…[N]o one, anywhere, is immune from poor quality of care [in the U.S.],” says lead researcher Rita Mangione-Smith of Seattle Children's Hospital Research Institute.

2. “[C]hildren in the U.S. do not routinely receive regular weight and measurement checks.

3. Children do not get “widely recommended screening tests, or standard care for asthma and diarrhea.”

4. “Sixty-two percent of children were not screened for anemia in the first two years of life, although the test is recommended for all babies.”

5. “Only 38% of children received the proper care for acute diarrhea, one of the main causes of hospitalizations in children under age 5.”

The researchers blamed much of the care deficit on insurers, whom they said pressure doctors to spend only ten minutes on a regular checkup, leaving them little time to run all the recommended tests. "Until now, most people assumed that quality was not a problem for children," says Elizabeth McGlynn, associate director of Rand Health and a co-author of the study. "This new study tells us that's not true."

Ironically, another story from the same day reports that Senator John McCain, once considered a favorite for the Republican presidential nomination, has determined that his prescription for providing better healthcare for Americans includes “passing tort reform to eliminate frivolous lawsuits and excessive damage awards.” This conclusion is based on what evidence? Could it be based on the study, also published by the NEJM, that the cost of the medical malpractice system comprises less than 1% of the total healthcare costs in this country? Could it be based upon the fact that the actual statistics from the National Practitioners Database (the Congressional-mandated data reporting on lawsuit payments by doctors and hospitals) demonstrate that insurance companies made up the “medical malpractice crisis”? Maybe he made his determination about lawsuits from the study published in the May/June edition of Health Affairs magazine, concluding that malpractice premiums constitute only a small portion of the expenses of physicians, even those in “high-risk practices such as neurosurgery and obstetrics. See here.

One thing that we must all be vigilant about is the continuing efforts of insurance companies to distort the facts about the healthcare that they control, finance, and propagandize about. If you don’t want to believe the trial lawyers because you think they have an agenda with which you do not agree, then believe the scientists who produced studies published for Health Affairs and the New England Journal of Medicine. Most of all, be wary of politicians who claim to have a fix for something that is nothing more than a myth.

Michael Townes Watson, author of America’s Tunnel Vision—How Insurance Companies’ Propaganda Is Corrupting Medicine and Law.

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Posted at 3:23 PM, Oct 11, 2007 in Health Care | Health Insurance
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By intimidating doctors by frivolous, but ruinous and disruptive litigation, John Edwards caused a surge in delivery of babies by C-Section. Babies delivered by C-Section have significantly higher rates of both hospitalization requiring asthma and diarrhea in infants.

A lawyer causes an epidemic of childhood disorders by filing frivolous claims. Another lawyer criticizes doctors for inadequate management of these.

Posted by: Supremacy Claus | October 11, 2007 8:28 PM

It is always essential to look at the economics of medicine. This is how medicine is paid for. A child has a fever and goes to the ER. The fever is a virus and it is pretty clear on exam. There are however rare things that that are not cost effective to test for but if missed can result in a lawsuit, so the child gets a CBC, chest xray, lumbar puncture after the ct is normal. Total cost, $4500.00. That money is now spent and not available for preventive care.

There is only so much money to go around. Right now it is spent on urgent care and un-needed tests. Why are all these tests needed? You cant go to a jury and say that 99.9% of the time these symptoms are due to a virus and not due to some rare thing that results in a huge tort payment. As a result most of our health dollars are spent in a way that does not result in the best care for the most patients. If we want the best care for the most patients we have to accept the economics and spend our healthcare dollars wisely. Part of this is to decrease the incentive to flagrantly spend more money, i.e. jackpot awards.

I have not heard how our present tort system allows the best care for the most people. So far all I have seen is how it allows health insurance companies to make more money by raising premiums and keeping attorneys in business.

If we really want to raise the standard of care in America, then we need to spend our health care dollars wisely. As an aside, it is hard to get people to come to the Doctor when they are healthy.

Posted by: throckmorton | October 11, 2007 9:05 PM

Thanks for this post; it is important for people to start hearing how doctors are being prevented from giving medically necessary care by insurance industry restrictions. Another example not mentioned in the post is the vaccine scheme. States require kids to receive something like 20 vaccinations now, but don't require insurers who do business in the state to pay for the actual cost of the vaccines plus labor. Instead, the insurers are free to make up whatever number they want for the cost of the increasingly expensive vaccines, and doctors are left holding the bill. This doesn't just impact doctors, it impacts other children; because doctors are shortchanged by private insurers, many now are unable to take kids with public insurance because of the low reimbursement rate. For example, Tri-Care (the military insurer) reimburses vaccinations below cost itself, meaning that many doctors now refuse to accept military health insurance. This gets into a whole side discussion about pharmaceuticals that is worthy of another post.

The takeaway point to all of that is that child health care isn't a matter of litigation, it's a matter of public health. From both a human rights and economics perspective, preventative care makes sense; we need to make sure that all insurers, public and private, understand and implement that key principle.

Posted by: KevinH | October 12, 2007 1:36 PM