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Minnesota 2020 Journal: Keeping Small Health Problems Small

May 02, 2014 By John Van Hecke, Publisher

MNSure’s first open enrollment period closed with 170,000 registrants. That means 170,000 Minnesotans are expanding Minnesota’s insurance risk and healthcare service pool, lowering everyone’s costs while improving care. This big number has an immediate, practical application underscoring affordable healthcare’s true value: access to healing care.

Last week, I was diagnosed with pneumonia. I can’t recommend the experience. I spent the previous week believing that I had whatever late season lung congestive crud that was going around. And, I may have. By Easter weekend, it wasn’t getting better.

When I confessed to my spouse that I was coughing up blood, she didn’t go through the roof but did take me by the ear to Urgent Care. This was Tuesday, a week ago.

I was promptly diagnosed. By noon, the chest x-ray and blood work results confirmed that, yes, in fact, I had pneumonia. Start to finish, from arriving at Urgent Care to ingesting the first pill, the whole process took four hours, tops. Antibiotics and rest are pneumonia’s chief treatment therapy. That also sums my last ten days or so.

My out-of-pocket costs were deceptively cheap. A twenty dollar Urgent Care co-pay, eight bucks of antibiotics and another $60 for pharmaceutical grade cough syrup and a nebulizer. For less than $100, I readily accessed and received the most efficient, attentive and speedy pneumonia treatment in human history. The key word here is deceptively. Focusing on out-of-pocket costs as the principal cost metric misses the healthcare mission and miracle.

Consider the x-ray. German physicist Wilhelm Rontgen published his paper identifying x-rays’ properties in December 1895. A month after that, the x-ray was first used diagnostically, creating the field of medical imaging and transforming healthcare. One x-ray is astounding. Billions of x-rays, systemically used to guide treatment are nothing short of a miracle. They are fast, safe, effective and cheap.

Volume makes the x-ray cheap but it’s still a deceptive cost because it’s only one link in a chain. The x-ray tech led me to lab, set up the exposure and processed the image for my Urgent Care doc. The staff Radiologist later studied my x-ray, affirming my pneumonia. The MDs involved, after finishing four-year undergrad degrees, attended four years of medical school followed by medical residency and, in the cast of the radiologist, probably two more years of specialized training. Add the RNs, specialty care techs, CNAs and administrative support staff, including all of the back-room paperwork processing staff that we never see, and reading my x-ray to diagnose my pneumonia is a monumental care achievement, repeated tens of thousands of times a day, all over Minnesota.

I have no idea what that x-ray, much less my entire treatment cost. I know that my healthcare provider and my insurer have a service contract paying for my treatment but determining the stand-alone cost of a single element is just about impossible. I know that volume lowers cost just as the insurance plan’s participant pools mitigates risk’s cost by spreading costs among a larger group of people.

Affordable healthcare serves everyone. It keeps small problems small. I’m keenly aware of what happens when pneumonia is left unchecked. It kills you. My family, my community and my employer are best served by having a healthy me around, making productive contributions rather than being absent. That’s the point that conservative healthcare reform critics miss. We all do better when we are all healthy, doing better. Yes, healthcare is expensive but innovation and organizational care efficiencies work to lower cost and improve health outcomes. The alternative is far costlier.

MNSure’s first open enrollment period is just that, it’s first. There will be many more to come. Affordable healthcare is a program, a law, and an aspiration. Five years from now, we’ll have a much clearer sense of what works and what needs improving. The program and the law will require improving but the aspiration remains unfettered.

I hope that the 170,000 new MNSure enrollees don’t experience pneumonia but we all rest easier knowing that they’re part of the great affordable healthcare nexus that keeps everyone healthier. Experiencing ill health is central to the human condition. So is treatment and recovery. Being sick is normal but disease, in many cases, can be minimized. In return, we experience the hope expressed in the American Declaration of Independence as the inalienable rights of “life, liberty and the pursuit of happiness.” If good health isn’t happiness, I don’t know what is.

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