The ACC was lucky enough to have two members, Westby Fisher, MD, and Sarah Clarke, MD, attend ACC.10 & i2 Summit and blog about their experiences. As their final post, they each addressed two patient scenarios all too common in the U.S. health system: one patient with good health insurance and one patient without (in the U.K., this translates into one patient with private health insurance and one with coverage from NHS). 

From the U.S. perspective, Dr. Fisher outlines the expected costs that Fictitious Patient #1 will incur. Thurgood Powell has a $5,000 annual deductible, which significantly defrays that $440,000 worth of medical care he receives after receiving a drug-eluding stent, elective bypass surgery, and finally ICD implantation and home monitoring.

Fictitious Patient #2 (humorously named Mortimer T. Schnerd) is not so lucky. Why? Because he’s uninsured. Without insurance to pay for his expensive bills, Schnerd receives his care at the public clinic with some coverage by Medicaid. If he’s “lucky” and it is determined that Schnerd is disabled enough by the heart condition, he could eventually qualified for Medicare, which would make it a lot easier (although by no means easy) to find a health care provider to provide follow up care. Because let’s face it, with the rate that Medicaid reimburses physicians, it’s like finding a pot of gold at the end of a rainbow to find a provider who will take a new Medicaid patient.

Meanwhile, over in Britain, things are a little bit different. Dr. Clarke writes about how during emergency situations (like, say, a heart attack) even with private insurance, patients are treated through NHS. The only difference in Powell and Schnerd’s care if that Powell “can choose his physician, ... will receive treatment more quickly and at a convenient date compared to the NHS” and “has a more comfortable stay in a private en-suite room in the private wing of the hospital.”

Thoughts
Drs. Fisher and Clarke’s analysis bring up some interesting points, given the historic health care reform bill that was just signed. To begin, Schnerd’s going to have more options for insurance from now on. Beginning in 2014, he’ll receive tax credits to help him purchase health insurance from an exchange, as well as help with his deductibles and copays. He won’t be expected to spend more than $695 to $1,096.20 on premiums, with maximum out-of-pocket costs for deductibles and copays capped at 15 percent of the total costs. If he doesn’t get any insurance though, he’ll be stuck paying a fine of about $695 per year. (See how the health insurance law will affect you with the Washington Post’s calculator).

Powell on the other hand, won’t see any changes under the bill. Based on this scenario, that seems to work out well for him. 

At least in the NHS system, as Dr. Clarke points out, no one has to pay to receive the treatment they need. They just need to have money if they want the treatment when they want it (as opposed to when the system wants to provide it) and for any luxuries. This delay can certainly lead to problems... problems getting timely access to care (which in CV care can mean the difference between life and death) and problems getting care at a time that works for your schedule. It’s a classic battle between cost and timely access. We’ve heard it over and over again during the health care debate.

Dr. Fisher is careful to avoid any discussions beyond the facts, but I think it’s important to note one other thing about Schnerd’s care: You can be sure that if Schnerd was an actual person without health insurance and he received $440,000+ worth of medical treatment, he went through A LOT of emotional distress thinking about how to pay for it. In this case, yes, he ultimately had his bills covered. For a lot of uninsured people though, this is not the case. They become saddled with thousands, if not tens of thousands, dollars worth of medical debt. That’s not a health care system, that’s a health care disaster.

Which is why the health reform bill passed. It’s far from perfect – and there are many provisions the ACC simply cannot support – but it’s a recognition that the system is flawed and needs reform. Rest assured, the ACC will be working with Congress, the President and Secretary Sebelius to seek amendments and push to add tort reform.

A Big Thank You
Finally, I want to close with a big “thank you” to Drs. Clarke and Fisher. Each did a spectacular job covering the science at ACC.10 & i2 Summit, providing a unique experience for readers. Covering three days of breaking trials and the latest science certainly isn’t an easy task, and after a long day of sessions, they both still managed to squeeze out several very thoughtful blog posts a day. All I can say is WOW. And of course, in my typical style -- THX!

Image Credits: Zscout370
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