The currently proposed health care legislation will have a severe impact on rural Arizona. While the goal to provide equal health care insurance coverage to every American seems worthy, health insurance does not equal health care. The delivery of health care in the United States has evolved in a very complex way. Any legislation with a goal of “fixing” American medicine needs to take into account not only the payments for services, but also the allocation of services.
I have practiced cardiology in both Massachusetts and Arizona. The 2010 Census will find that the two states now have the same population and age demographics, and consequently the same health care needs in an equal society, but they have very different resources.
Physicians 2008 17,248 34,320
Registered Nurses 2008 37,780 79,670
Physician Assistants 2008 1,668 1,725
Hospitals 2007 66 78
Hospital beds/1000 population 1.9 2.6
Medical Schools 1 4
The data listed above show a striking difference in the resources of the two states. Before moving to Arizona, I practiced in Boston, where there are three medical schools within a radius of a few miles; every imaginable medical diagnostic and therapeutic resource is immediately available.
These resources cost money and have developed over years. In the early days of Medicare, reimbursement was very generous. It included extra reimbursement for teaching hospitals, which were able to reinvest this revenue in their facilities. Large hospitals affiliated with medical schools were able to generate huge endowment portfolios.
Massachusetts receives higher Medicare payments for every procedure than Arizona, the difference is based on cost of living, but the adjustments are likely excessive.
A complete echocardiogram in Arizona in 2010 is $229.82, in Massachusetts $295.15 — 28 percent more!
Massachusetts receives additional federal money to support universal health care. When I was chief of cardiology at the Carney Hospital, Teddy Kennedy was a perennial guest at fund-raisers, and he would invariably show up with a million dollar earmark.
So if the people of Massachusetts have such great health care, why did they elect Scott Brown who promised them he would vote against the health care bill? Health care is a commodity with nearly insatiable demand, but expensive infrastructure.
A new cardiologist goes through 10 years of training after college. When Massachusetts made health care free for everybody, demand went up; health insurance costs have risen 30 percent annually since 2006. Although the state has arguably the best medical infrastructure in the country, it was already at capacity. Now the state is in a financial mess and proposing strict price controls on health care services.
The universal health care plan initially did not try to control costs, but the current national legislation proposes strict controls. It also proposes to cut Medicare by $500 billion at a time when the Medicare population will be growing faster than ever before, especially in Arizona.
The controls will be particularly severe in medical imaging; for us this will be disastrous. The proposed legislation plans to cut costs by drastically reducing reimbursement for equipment based on utilization. Rural areas like Payson with a medical service population of only 35,000 will not be able to afford expensive equipment. With the same population as Massachusetts, and fewer than half the resources, Arizona will experience health care rationing.
The proposed health care bills may provide health care insurance, but you will not get health care. The immediate result of price controls with limited infrastructure will be long waits for service
.It is time to start over with carefully designed sequential programs enacted over many years.
Ann Kirkpatrick, our representative in Congress, voted for the first iteration of this bill, she needs to know how it will affect you.