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Health Care Access vs. Coverage
Houston Chronicle
Sunday, August 24, 2008
By: Senator John Cornyn
Until recently, family doctors throughout Texas were being driven out of our state, and even out of business, as medical liability insurance premiums skyrocketed. Specialists and primary care physicians were forced to weigh the financial practicality of offering certain services or working in certain communities.
Predictably, patients paid a high price as well. Expectant mothers had difficulty scheduling appointments with an obstetrician-gynecologist and those in rural Texas communities often had to drive long distances to meet with an experienced physician.
Fortunately, critical relief came in 2003 when Texas passed Proposition 12, which placed responsible limits on medical liability lawsuits. Since then, medical professionals have flocked to Texas to practice medicine. More doctors provide more choices and greater access for patients.
A recent article in Texas Medicine lauded Texas as a "model state" in attracting experienced doctors and noted that "Texas' success in achieving and preserving medical liability reform has inspired other states." The article also reported that "because Texas hospitals and physicians alike no longer have to allocate as much funding toward paying exorbitant insurance premiums or heavy settlement awards, they're able to pass the savings along to patients and staff members."
It was this documented record of success and achievement in one area of the much-larger health care debate that I was referring to in my recent remarks to the Greater Houston Pachyderm Club. Unfortunately, the Houston Chronicle editorial board chose to report these remarks out of context. The Chronicle suggested instead that I was praising health care generally in Texas and ignoring the problem of the uninsured.
To be clear, the number of Texans without health insurance is unacceptably high. In fact, it's shameful. According to the Institute of Medicine, the uninsured are less than half as likely as persons with insurance to receive necessary health care, particularly preventive care.
Any responsible debate on health care must recognize the differences between coverage and access to care. Coverage means someone has a health insurance plan. But, coverage alone does not guarantee access to health care services. For example, The New York Times reported recently that despite passing universal health care coverage and investing millions of taxpayer dollars, Massa-chusetts has fallen drastically short in providing health care to its citizens. There is a shortage of doctors, long waiting lists and little reduction in those going to emergency rooms for primary care.
Expansion of insurance coverage is just one piece of the health care puzzle. Those who think otherwise do not understand the true problem.
Another misconception is that having a job will guarantee health care coverage. In fact, the majority of Texans who do not have health care insurance are employed. Many work in small businesses or are self-employed. Unfortunately, a high percentage of small-business employers cannot afford to contribute toward their employees' health care coverage.
One way to ease the burden is to allow small employers to compete in the same way as large employers in the health insurance market.
The United States spends, by far, more money per capita on health care than any other nation. Yet, these extra costs do not necessarily result in improved outcomes or higher quality care. Many of America's insured may soon join the ranks of the uninsured if we do not treat the inherent problems of our current system that lead to high health care costs.
For example, we should reform the tax code, which unfairly punishes those who receive their insurance cover-age through the individual market.
Portability is another issue to address. When you change jobs, you don't have to change auto insurance. Why should health insurance be different?
Additionally, we should strengthen transparency and accountability in the health care market to allow patients to become better consumers. Lack of information and competition helps to explain why the same health insurance policy costs $8,334 in North Dakota but $10,312 in South Dakota. If consumers in South Dakota could buy that North Dakota policy, prices for health insurance would go down. Why can't they?
Along with increasing the use of health information tech-nology and the delivery of pre-ventive care — which provide coordinated, quality care — these are just a few of the ways our country should be working to address our health care crisis. This isn't an issue that we can afford to neglect. We must treat our ailing health care system quickly.
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