Pediatricians Have Accomplished More With Less for Years -- See What We Do!

Geoffrey R. Simon, MD


May 07, 2010

Although the devil is in the details, the greatest beneficiaries of the healthcare reform bill are children, whether insured privately or through public insurance, ie, Medicaid. The evidence is irrefutable that investing in children's health, both in prevention and in managing chronic childhood diseases, such as diabetes mellitus and asthma, early in life results in improved quality of life for children and the adults that they grow up to be. The long-term costs savings of preventive care, the greatest return on investment of healthcare dollars, resides within pediatrics. However, for too long children have been regarded as second-class citizens.

Consider that, for years, most states have been paying only 40%-70% of Medicare rates to physicians caring for children covered by Medicaid, so that most pediatricians or pediatric subspecialists lose money caring for these children. Does this mean that, to our American society, a child's life is worth less than half of his grandfather's life? Shameful! The reform bill takes a first step in bringing Medicaid rates up to parity with Medicare. Although this is only guaranteed for the first 2 years, it is a beginning.

For privately insured children, the issue of pre-existing conditions resulting in uninsurability or in exclusion of coverage related to those conditions has been a big problem. With the new reform bill, children cannot be excluded from coverage or charged a premium for pre-existing conditions. Numerous times I have had families in which parents lose jobs and thus insurance, or they might start a small business and are unable to get insurance for their children. Such families may pay $1200 to $1700 per month, but because their child has asthma, still cannot get coverage for any care or medications related to asthma for the first 2 years of the policy. So the child stops taking the asthma medication and ends up having a severe exacerbation resulting in a trip to the emergency department, which costs $3500. To add insult to injury, because this is a non-covered benefit, they have to pay list price.

Finally, with more children having access to insurance, including mandated coverage for preventive care, more insured patients will be provided to pediatricians who can benefit from our expertise in treating patients within the medical home. By doing so, we can further demonstrate financial and health benefits -- the greatest return on investments of any specialty in medicine. In pediatrics, we accomplish more with less every day. With a little more resources, we can accomplish even greater things for our children and our future as a nation.


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