Posts Tagged ‘SCHIP’
By now everybody knows that the Senate passed a healthcare reform bill last week. The House passed such a bill last month. The bills differ in important respects, and of course it is still unclear if the two bills will be reconciled in conference committee to produce a bill that both houses will pass. If a final conference bill does pass, it will have ground-breaking effects on medical care. What might change in the PICU?
My first-blush answer is that it will have important effects for me, my colleagues, and our patients, but not so much as it might for other aspects of medical practice. Why do I say that? First, look at where our current healthcare dollars come from (source is here):
Private insurance: 35%
Medicare: 19%
Medicaid and SCHIP: 15%
Other public funds: 12%
Other private funds: 7%
Out-of-pocket: 12%
These figures are for the entire system. As I’ve written before, the PICU is different — very different. Around half of children in the PICU already are covered by Medicaid, the joint federal/state program for children of poor families. This startling statistic is a reflection of the fact that poor children are far more likely than are affluent children to end up in the PICU.
But even though half the children in America’s PICUs are on Medicaid, half are not, and the healthcare reform bill can have a major impact on them, especially those from families who are presently uninsured. A PICU bill can bankrupt those families. This bill will reduce the number of times that will happen, and I think that is a good thing.
It is unclear what will happen after the president’s veto of the bill reauthorizing the State Children’s Health Insurance Program (SCHIP) and the inability of Congress to override his veto. John Iglehart, the highly-respected national correspondent for the New England Journal of Medicine, reviews the episode here. It is brief, understandable, and to the point. Whatever you think of the issue, it is clear opponents of the program misrepresented what it was.
But there is a deeper issue — quality, as well as quantity, matters. In a way, the SCHIP debate is about quantityof healthcare because it concerns access to care; children and adolescents are disproportionately more likely than adults to be poor, something SCHIP was designed to address. Another recent New England Journal article shows how qualityof healthcare for children is also a major problem.
This observation goes against the common wisdom, which has been that problems in quality of healthcare are not such a problem for children as they are for adults. The unspoken assumption has been that children’s conditions are somehow easier to diagnose and less complicated to treat than those adults get. So if the child could get to the doctor, then we presumed the child usually got the correct care. This is not true; deficiency rates in the quality of care for children were similar to those noted in adults.
What is the solution? We need to assume children are just as complicated as adults in their healthcare needs.
It is unclear what will happen after the president’s veto of the bill reauthorizing the State Children’s Health Insurance Program (SCHIP) and the inability of Congress to override his veto. John Iglehart, the highly-respected national correspondent for the New England Journal of Medicine, reviews the episode here. It is brief, understandable, and to the point. Whatever you think of the issue, it is clear opponents of the program misrepresented what it was.
But there is a deeper issue — quality, as well as quantity, matters. In a way, the SCHIP debate is about quantityof healthcare because it concerns access to care; children and adolescents are disproportionately more likely than adults to be poor, something SCHIP was designed to address. Another recent New England Journal article shows how qualityof healthcare for children is also a major problem.
This observation goes against the common wisdom, which has been that problems in quality of healthcare are not such a problem for children as they are for adults. The unspoken assumption has been that children’s conditions are somehow easier to diagnose and less complicated to treat than those adults get. So if the child could get to the doctor, then we presumed the child usually got the correct care. This is not true; deficiency rates in the quality of care for children were similar to those noted in adults.
What is the solution? We need to assume children are just as complicated as adults in their healthcare needs.
As I write there is a looming battle between Congress and President Bush over reauthorization of the State Children’s Health Insurance Program, or SCHIP. The program ends at the end of the month unless it is reauthorized. SCHIP provides health insurance to children in families with too much income to qualify for Medicaid but too poor to afford healthcare. It is a complicated question, well reviewed in a recent New England Journal of Medicine article here. The controversy boils down to what we think the government’s role should be in providing health care to children. Most support helping the truly poor, those below the federal poverty threshold of an income of $20,650 for a family of four, but many balk at giving public money to families making as much as twice that. Another issue is that the SCHIP reauthorization bill, as with many bills, was quickly laden with extraneous add-ons.
I support SCHIP because, without it, children in families slightly above the poverty line suffer. When these children get seriously ill they will end up in PICUs like mine anyway, and if they have no insurance the government usually ends up with the bill. If these children had insurance for preventative care, they may well have not needed the expensive PICU in the first place. I would much rather see a comprehensive overhaul of our medical system, but I despair of that ever happening until the inevitable time in the future when things really do fall apart. Meanwhile SHCIP is a band-aid, but I think it is a needed band-aid.
Addendum: Here is an update–it looks as if some compromise will pass. Whether the president will sign it is another matter, of course.
Another addendum: Here is another update–a compromise passed both houses. It’s still unclear if the president will sign it.
Update: President Bush has vetoed the bill. It is unclear at this point if Congress will have sufficient votes to override the veto, but most expect that the Democrats will try to do this. They will need to attract Republicans to do so.
Sachin on 