HJAR Jan/Feb 2020

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2020 51 LaShannon Spencer CEO Community Health Centers of Arkansas an arena we must expand, especially if Medicare for All, or some version thereof has any hope of becoming a reality. There are some critical, unanswered ques- tions: Howmuch will hospitals and doctors be compensated for services under Medi- care for All? Some physicians already limit the number of Medicare patients they will accept because, they argue, federally estab- lished Medicare reimbursements are too in- sufficient to pay for the actual cost of phy- sician care. Will these proposed measures reduce payments that can impact hospital payments as well?What about the Medicaid disproportionate share hospital payments (DSH funding/payment) that many hospi- tals rely on for the uncompensated care that they provide? These payments help to im- prove access for Medicaid and uninsured patients, as well as provide a little financial stability for the safety-net hospitals. And what about reimbursements for pre- ventive healthcare services? How will they be altered? Yes, the Medicare for All debate does, even if accidentally, shed some light on how much we need a renewed focus on primary preventive care, and what that gen- erally means for health outcomes. Evidence on whether expanding access to preventive care lowers overall costs remains limited. But there is ample evidence that preventive care leads to improved long-term health outcomes in individual patients. Improving access to timely and high-quality primary healthcare is a key cornerstone of any health determinants of health (factors that affect one’s health, such as poverty and education levels) and the overall health of rural and urban communities alike. We must discuss collaborations among key stakeholders, including physicians and clinicians, that empower communities by ensuring healthy food options, walkable spaces, affordable and habitable housing, public transportation that takes a body to a good, paying job. These too are tools in the arsenal of preventive healthcare. For more than 50 years, President John- son’s landmark healthcare endeavors, Medi- care andMedicaid, have been protecting the health and well-being of millions of Ameri- can families and saving lives, and thereby improving their economic security. Both are laudable, but also imperfect. Extending Medicare to everyone sounds ideal. But, we must transform those snappy soundbites and headlines into something broader and more profound and more helpful. If we can first fix some of the prob- lems plaguing patients and physicians, then maybe Medicare for All can be more than mere words to sling and spout on the campaign trail. Let us make a stronger in- vestment in primary and preventive care services, like those provided through the Community Health Centers of Arkansas and similar networks nationwide, before moving to a single-payment system to which some politicians now seem merely to be paying lip-service. n reform plan. But lowering or eliminating pa- tients’deductibles, out-of-pocket costs, and so forth could push more patients into the healthcare stream, further draining federal healthcare resources. So, Medicare for All may give people the health care they need, but likely won’t yield cost savings. I worry that, under Medicare for All, the pace of hospital closures will quicken as hospitals that are barely able to keep their bottom lines in the black suffer more reve- nue shortfalls. I worry that more doctors and would-be doctors will move instead into, say, the insurance industry, where they might earnmore—and lessen their workday stress— or utilization-review consultants, deciding which medical treatments will be covered and which won’t. I worry that Medicare forAll could signifi- cantly reduce access for rural communities already grappling with shortages of health professionals and hospital closures. Having health coverage means nothing when there is no doctor in town, and when the ambu- lance doesn’t get a sick patient to the nearest emergency department on time. Right now we, the people, need more than a card prov- ing that we have health insurance. Amid the grandiose political chatter aimed chiefly at winning votes, not neces- sarily at actually guaranteeing healthcare access, we must demand some real talk of how we can address the question of ac- cess. We must discuss how broader health- care access can positively impact social “Medicare for All may give people the health care they need, but likely won’t yield cost savings.”