Health Care System's Biggest Problem Isn't Cost; It's Quality

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Do doctor visits cost too us much? Do we need Obamacare to bring these costs down? A recent survey conducted by Consumer Reports suggests the answer is not the obvious "Yes!" you might think.

Three years after the Patient Protection and Affordable Care Act was signed into law, many of its major provisions have yet to take effect. And yet, we know the broad outlines: Once in full force, Obamacare will extend medical insurance to millions of previously uninsured Americans; eliminate the need for the nation's many currently uninsured patients to seek basic health care at expensive emergency rooms; enable patients to apply for new insurance coverage without being denied based on preexisting conditions; and ask everyone in America to sign up for a health plan or pay a penalty.

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There are other details to the law, of course. With the Obamacare document stretching past 2,000 pages in length, that stands to reason. But when you put all the parts together, the result is that the overall cost of health care for America as a nation is supposed to fall.

Now here's something that may surprise you: You know how the high cost of health care was the impetus behind Congress passing Obamacare in the first place? Turns out, when you ask actual patients what they dislike most about America's health care system, "cost" isn't always at the top of the list.

Here's What Really Gives Us Headaches About Health Care

Surveying the opinions of 1,000 Americans in a recent poll of their biggest "gripes" about doctor visits, Consumer Reports discovered that whether or not patients think medical care costs too much, they're pretty darn sure that they're not always getting what they're paying for.

What bothers many Americans -- maybe even more than the cost of medical care -- is the quality of that care.

You can read the entire report on CR's website here, but here are a few highlights to ponder:
  • Doctors who can't clearly explain what ails patients ranked as patients' No. 1 concern -- scoring 8.1 on a 10-point scale, with "10" being patients' biggest gripe.
  • Slow turnaround on medical test results was patients' second-biggest concern (7.9).
  • And the third most important concern?: "Billing disputes" with doctors and insurers -- scoring a 7.8.

As a broad category, problems with medical care "supply" ranked pretty high as well. Patients listed difficulty getting a quick appointment with a physician, "rushed" office consultations, and discharges from the hospital before they were ready as their fourth, fifth, and sixth concerns, respectively.

Complaints No. 9 and 10 -- long spells spent sitting in the waiting room, and inability to get a doctor to return phone calls and emails -- also fit within this category. And you can probably add complaint No. 12 -- inconvenient office hours -- to the category of too little medical "supply" as well.

The Upshot

Cynics may look at these results and dismiss them with a simple quip -- "So, newsflash: Sick people complain a lot." But when figuring out how to implement Obamacare so it makes the most people happy, to counterbalance all the people who are unhappy with the law, Congress might want to give this month's Consumer Reports poll a quick skim.

The upshot here seems to be that if cutting costs requires cutting corners on access and quality of care, voters might not be so eager to embrace Obamacare as legislators would like to think.

And referring back to that No. 1 concern: If you want to improve patient satisfaction with their quality of care, spending a bit of money teaching doctors to communicate better might be a good investment. While you're at it, see if you can get a few of these doctors signed up for a quick refresher course in penmanship. Because prescriptions don't write themselves.

Motley Fool contributor Rich Smith once spent more than a year trying to get a billing snafu between an insurer and a health care provider fixed. He'd bump that "billing dispute" gripe up from No. 3 to No. 1, if Consumer Reports had asked him.

Obamacare's Reach - Which States Will Benefit the Most and Least
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Health Care System's Biggest Problem Isn't Cost; It's Quality

According to a study conducted by the Department of Health and Human Services and the nonpartisan Henry J. Kaiser Family Foundation, Kentucky will be the biggest winner in the proposed Medicaid expansion. Currently, 16.1% of Kentuckians under 65 are uninsured. The new Medicaid rules will reduce the number of poor people without insurance by 57.1%.

Kentucky voted for John McCain in 2008.

Currently, 18.7% of Oregonians under 65 and 12.8% under 18 don't have health insurance. Under the proposed Medicare rules, the number of poor people without insurance will drop by 56.7%.

Oregon voted for Obama in 2008.

Times are tough in the Mountain State: 18.6% of West Virginians under 65 are uninsured. If the state adopts the Medicare rule change, the number of uninsured poor people will drop by 56.7%.

West Virginia voted for McCain in 2008.

South Carolina Gov. Nikki Hailey has already vowed to reject the Medicare expansion. Her state has one of the highest percentages of uninsured citizens: 19.9% of South Carolinians under age 65 don't have insurance. 12.7% of children under 18 are also uninsured. Under the proposed new Medicare rules, the percentage of poor people without health insurance would drop by 56.4%.

South Carolina voted for McCain in 2008. It's also where the first shot was fired in the Civil War.

Like South Carolina, Mississippi has also announced its plans to reject the Medicare expansion. And, like South Carolina, it could especially use the health care funds: 20.2% of Mississippians under 65 and 12.7% of those under 18 don't have insurance. Under the new rules, 54.9% of those poor people currently without health insurance would get it.

Mississippi voted for McCain in 2008.

At the other end of the scale, Delaware is one of the states that stands to benefit least from a Medicare expansion. Only 11.8% of people under 65 in the state are uninsured. Still, with the new rules, the number of uninsured people under the poverty line would drop by 15.9%.

Delaware voted for Obama in 2008.

With an uninsured population of just 13.3%, New York also won't get much out of the new Medicare expansion. Even so, the number of poor people without insurance in the Empire State will drop by 14.8%.

New York voted for Obama in 2008.

Arizona has one of the highest percentages of uninsured citizens: 21.2% of people under 65 and 16.2% under 18 don't have insurance. Even so, the Medicare expansion won't help the Grand Canyon state all that much: it will only reduce the number of poor people without health care by 13.6%.

Arizona voted for McCain in 2008.

Vermont has one of the lowest uninsured percentages in the country: Only 10.4% of its citizens don't have health coverage. Not surprisingly, the Medicare expansion won't help that much -- it will only reduce the number of uninsured poor people by 10.2%.

Vermont voted for Obama in 2008.

Photo: Skeddy in NYC,

Thanks in large part to Mitt Romney's statewide health insurance program, Massachusetts is the best-insured state in the nation. Only 4.6% of citizens under 65 and 2.1% under 18 aren't insured. Not surprisingly, the Bay State will also benefit least from the Medicare expansion: it will only reduce the number of poor people without insurance by 10.2%.

Massachusetts voted for Obama in 2008.

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