Nevada County Picayune and Gurdon Times Newspaper Archive

For health care: Outlook not promising

Changes in the medical profession will likely get worse before they get better, especially where Medicare and Medicaid are concerned.

This is what members of Leadership Nevada County was told by Dr. Michael Young and Dr. Alan Fox at a recent Leadership meeting.

The two physicians agreed the medical situation nationwide is currently bleak.

Young has been practicing in Prescott for 30 years. He said malpractice insurance is expensive and is an ongoing problem as few companies want to write such policies in Arkansas.

Rural health care, he said, is a major issue in the state as well. This is because most doctors come out of medical school owning more than $100,000 for their education, and this doesnt include their personal indebtedness. Places with money can recruit doctors, and thats now what was done 30 years ago.

Young said he was $26,000 in debt when he came to Prescott and the federal government helped pay for student loans.

The biggest problem, he said, is the fact the government is looking to make 4-5 percent across the board cuts in Medicare and Medicaid budgets. This wont help the situation. There are clinics in Little Rock where when a patient turns 65 they are turned away because the clinic doesnt take Medicare.

According to Young, under the Diagnosis Related Group (DRG), there is a point where people get free care with Medicare. This is because DRGs are different, with some based on per diem (per day) pay and others being flat rates. When the maximum amounts are reached, he said, and the medical care is still needed, the patients literally get it free because they cant be refused treatment.

Historically, Young said, the gaps in the costs of running a medical facility was offset by third party insurance, but over time, everyone adopted the Medicare fee scale and third party insurers reduced the amount they are willing to subsidize.

There is no free care, but there is a lot of non-compensated care, he said.

Emergency room visits, he said, for Medicare patients have almost doubled in the last 10 years. This is because fewer doctors accept Medicare. The end result, according to Young, is more pressure is put on the ER doctors, staffs and facilities because most of the ER visits arent emergency cases. ER medicine is expensive.

Fox talked about the pharmaceutical industry and Medicaid. He said the state pays for them on a formulary basis, based primarily on price. The government controls 56 percent of prescription drugs. Drug company representatives come and see us in a panic because no one is sure of the future.

Additionally, Fox said, insurance co-pay keeps going up, as does the cost of generic and name brand drugs. The pharmaceutical industry could be hurting in the next few years with government paying less for medicine.

According to Fox, there are ways around the cost in some instances for those who arent able to pay. Sometimes, he said, pharmaceutical companies provide free medicine, or a discount card for those who dont have insurance. Pharmacies dont like the cards, he said. This is because the pharmacies arent reimbursed the cost of some medications.

It is legal, Young said, for people to go to Mexico and get medicine for personal use and bring it home. The same applies for those who go to Canada. A lot of the drugs are American made. The pharmaceutical industry isnt selling medicine to Canada at a loss.

The two discussed socialized medicine, such as practiced in European countries. Both agreed part of the problem with this is having to wait months for medical care. In some instances patients die before they can get in to see a doctor.

They also said there are places in America where boutique medicine is practices. Boutique medicine, in a nutshell, is for the wealthy. In it people get together and form a type of club where they literally have a doctor on retainer, like a lawyer. The doctor is available to the club members when needed.

Part of the problem in the US, they agreed, is the lack of preventative medicine. The best bang for the buck is childhood immunization, Young said. Civil engineers have done more to prolong life by providing clean water and flush toilets.