Saturday, January 14, 2017

The Very Sick Patients-Some Further Perspectives

The Very Sick Patients-Some Further Perspectives

I got some interest in my article about Trumpcare. I want to clarify more about the very sick patients.
About one year ago, I was watching television in my study. Quite by accident I stumbled upon a great documentary shot in rural Virginia. It was an area inhabited by what I would call “poor white people.” They had very low educations and very low job achievements in life. (Please my father’s family came from those same Appalachian roots. I’m not “looking down my nose at these people.”)
For decades these people had no healthcare in the area where they lived. Then a non-profit organization purchased a used recreational vehicle and equipped it as a clinic on wheels. The vehicle was staffed by nurse practitioners, but no doctors. The interaction of the new patients with their health care providers was shown. Some people in that area were helped by the new health care services. Some people had chronic illnesses and died. No one was sad or indignant when one of these very sick people died. There were no protesters going to Richmond. There were no indignant posts on social media. These humble and very sick people died with little or no notice. (Everyone the documentary was shot during Obama’s presidency. I’m not criticizing Bush II or Trump!)

Let us step back for a moment and look at this very sick population. Let us go back to Alaska. As of 2014 their population was 736,732. When the state legislature and the governor did their study of the health care system they found 500 very ill patients. 500 in a population of 736,732 is a tiny minority of .0006786728% of the population. This tiny minority generated healthcare costs of $55,000,000 per year or an average of $110,000 per patient.

I honestly believe that we will see Trumpcare charge this tiny and expensive minority very high insurance premiums that they can’t pay or push them back onto the states. When this is done, it might not even be necessary to force all the young people to sign up for health care coverage as Obamacare does. As is the case with Alaska, premiums will drop and deductibles might drop also. The great majority of the population will be satisfied with their new health coverage. The health insurance companies will be happy too because they will be rid of their most expensive clients.
What happens to this tiny, suffering and very expensive group of very sick people? If they are lucky enough to live in affluent states like Alaska, Hawaii, California, Oregon, Washington, Colorado, New York, Virginia, Maryland, New Jersey, Delaware, Mass., Conn., etc. these states will somehow find the money to care for these people. If these sick people live in many other states, they are going to have a problem. These states will not have the money to care for these people. The Republicans will offer block grants to these poor states to help with these healthcare cost. I doubt that they will cover even a small fraction of the actual costs.

Elena gets indignant about this situation. She points out that, by law, care must be given to any sick person. She is correct. In some states these sick and unfunded patients will overwhelm the local healthcare systems. Hospitals and clinics will go bankrupt and close. These sick people will be left with no healthcare at all. Like the sad people in Virginia in the documentary, they will die quietly with little or no notice.

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