No truer statement was uttered regarding the recent Erie County Medicaid report than that by the author when he said, “I think $2 billion is an indicator of how many problems there are in the health care delivery system in the United States.”
That’s $2 billion, with a “b,” the total cost that Erie County is soon expected to incur through its Medicaid program. The county pays a fraction of the direct costs of Medicaid but it’s still a bundle. In 2016, it was 11 percent of the total Medicaid bill, $205.5 million. This year, the county is expected to pay $203.8 million. But the total cost keeps rising.
As Erie County Medicaid Inspector General Michael Szukala and author of the report said, ultimately taxpayers are paying the bill. What is most curious is that the bill looks larger than one would expect.
The overall number of county residents on Medicaid is declining, leading the inspector general to speculate that an improving economy and that those interested and eligible for Medicaid under the Affordable Care Act in 2013 have already signed up. So, he no longer predicts that a full third of Erie County residents will be on Medicaid by 2021.
Yet New York State’s bill – and, by extension, Erie County’s – keeps getting bigger. Last year, Erie County got handed a nearly $1.89 billion bill; two years ago it was $1.78 billion and in 2008 it was $1.2 billion. Again, the state paid most of those bills, but the money all comes from taxpayers.
These are staggering sums. They point to the desperate need for reform in the country’s health care system. The fix isn’t going to come by cutting – and reductions in spending on Medicaid would be unfair and cruel to those who need the coverage.
Instead, smart people need to figure out a better way to deliver health care at a lower cost. One of the ways in which this can be accomplished is by employing value-based health care, a method practiced by a number of physicians, including in Western New York, according to Dr. Michael W. Cropp, president and CEO of Independent Health and a board-certified family physician.
In an Aug. 5 Another Voice on transforming health care, Cropp touched on value-based care, which focuses on evidence-based medicine, “while advancing safe, appropriate and effective care as opposed to a volume-based, fee-for-service model …” The latter tends to be “unneeded, duplicative and, in some instances, potentially harmful – tests, treatments and procedures.”
Value-based care may be one solution. There are certainly other paths. Increases in health care costs have become unsustainable.
The New York Times and other publications have cited figures stating that 1 percent of patients “account for 20 percent of the costs.” Moreover, 5 percent of the population makes up “nearly half of the nation’s health care spending.” Those people need medical care, but it needs to be delivered in an efficient and coordinated matter. Prescription costs need to be contained.
The focus should be on the exorbitant cost of the nation’s health care and how to bring it down. The rest should follow, although when it comes to health care math, not much is guaranteed.