John Goodman, of the National Center for Policy Analysis, comments on a new study published in the New England Journal of Medicine: “Who is at Greatest Risk for Receiving Poor-quality Health Care?” Contrary to many previous studies, the NEJM study found that, in Goodman’s words:
– Among people who seek care (actually see a doctor), there is virtually no difference in the quality of care received by the insured and uninsured.
– There is also very little difference in the care provided by different types of insurance – Medicaid, managed care, fee-for-service and so forth.
The study is consistent with Dallas-area data reported by Goodman in his book Lives at Risk. Goodman summarizes the implications of the NEJM study:
The entire Medicaid program (at a cost of $1,000 per person for every man, woman and child in the country and a huge crowd out of private insurance) is predicated on the conventional wisdom that being insured matters. Now we know that what really matters is seeing a doctor. Two deterrents are rationing by waiting and physician fees. Both hurdles could be overcome with funded health savings accounts.
Another conventional wisdom is that the uninsured need sky-is-the-limit coverage just like the United Auto Workers. But since the low-income uninsured have few assets to protect, why do people with modest means need such expensive coverage? They don’t. A scaled down plan could give them ample choice of doctors and allow entry into the system for much lower premiums.
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