For the first time in a decade, the number of uninsured children in the United States increased in 2018. Apple Health seemed like the quintessential success story because it expanded Medicaid coverage for children — in Kitsap County alone, the number enrolled grew from 9,000 to over 21,000 in the last 10 years. However, Medicaid reimbursement also decreased by more than 35 percent, after a federal provision that kept Medicaid payments on par with Medicare expired in 2015. Some states set aside funding to maintain rates equal to those of Medicare, but Washington was not one of them.
During the same period, the U.S. maternal mortality more than doubled, skyrocketing from 9.8 to 21.5 maternal deaths per 100,000 live births. That’s six times higher than most Scandinavian countries and three times higher than Canada and the United Kingdom. In the U.S., around 700-900 women die and another 65,000 experience life-threatening complications during or after childbirth. By any standard, the U.S. has the worst performance on this crucial measure of any country in the developed world.
Only 6% of physicians practice in rural areas, yet they serve 16% of the population. Kitsap County has 443 physicians, equivalent to 2.4% of the state total and is one county experiencing a shortage of primary care physicians. Kitsap County falls below the state average in every primary care specialty across the board.
In the fiscal fight over health care costs, pediatricians are on the chopping block. In hospitals and clinics across the country, pediatricians are being laid off in droves, leaving the clinical burden to mid-level providers, family physicians, and emergency room doctors. These decisions are being made by suits over scrubs, and they are putting patients at risk.
Mayo has fractured trust by misrepresenting operating losses in Albert Lea to justify hospital closure, Dr. Noseworthy condoned prioritizing patients based on their pocketbooks while third quarter earnings went through the roof, and hospital leadership condescendingly compared driving 23 miles in labor as being equivalent to buying ice cream.
Primary care physicians in the U.S. have been relegated to the back room. As a result, people are dying younger than before. One year ago, I asked whether declining life expectancy was just the tip of the iceberg, suggesting we should turn our attention to the dwindling supply of primary care physicians. What will it take for those in charge sit up and pay attention? How low will life expectancy have to go? Stay tuned…
Confucius said, “the man who moves a mountain begins by carrying away small stones.” It is time to lay the groundwork for Kitsap residents to formally engage in meaningful dialogue with leaders of our local hospital corporation, whether operated by CHI Franciscan, Dignity Health, or a still-to-be-named corporate entity.
Washington State Law allows vaccine exemptions on the basis of religious, philosophical, or personal reasons; therefore, immunizations rates are considerably lower (85%) compared to states where exemptions rules are tighter. Immunization rates are directly proportional to the narrow scope of state vaccine exemptions laws. Immunization rates are used to “rate” the primary care physician despite the fact we have little influence on the outcome according to scientific studies.
The idea of micro-hospitals is gaining traction because costs of construction are far lower than that of more traditional hospital facilities –costing anywhere between $7-$30 million, depending on the range of services available, according to Advisory Board statistics. Micro-hospitals can meet 90% of the community healthcare needs. They seem to flourish best in markets with critical service gaps. Ideally, micro-hospitals are located within 20 miles of a full-service hospital, facilitating the transfer of patients to larger facilities if higher-acuity needs arise. Hospital stays anticipated to be longer than 48 hours are sent to higher-acuity facilities.
Since the birth of our nation, labor unions have existed in one form or another in the United States. Unions are a force to protect the ‘working population’ from inequality, gaps in wages, and a political system failing to represent specific industry groups. The existence of unions has already been woven into the political, economic, and cultural fabric of America; it may be time for physicians and surgeons to unionize.