Hillarycare was already on the ropes in ’93 when Big Insurance landed a haymaker in the form of Harry and Louise, a TV commercial series featuring 2 everyday Americans scared sleepless that health reform meant government meddling and bloated bureaucracy. 

Now, the Big O claims we can’t tame deficits without a health care do-over and HHS nominee Kathleen Sebelius adds that 40% of recent home foreclosures are related to financial stress caused by uninsured health expenses, so it would be vexing indeed if Big insurance scuppered reform yet again.

At first it seemed to be on board, floating constructive proposals and even manning up for the Big O’s morning teas.

But recently, things have turned frosty.

Big Insurance has warned it will oppose any plan involving a government-sponsored insurer that competes against the privates, a cornerstone of several reform proposals, including those of Speaker Nancy Pelosi and Sebelius herself.

And don’t look now but Big Insurance may secure providers as allies on the matter.

Mayo Clinic boss Denis Cortese is on record for example, with concerns that a public insurer would underpay providers, as Medicare has done to Mayo, according to Cortese, to the tune of $840 million in the last year alone.

Meanwhile, Harvard health economist Regina Herzlinger has pointed out that the apparent cost advantages of a government run program are in part an artifact of accounting trickery.

The Feds don’t have to set aside funds to meet future obligations like Big Insurance does, she told the Economist. “The government does not have the $36 trillion needed to finance the services it has promised to those who pay for Medicare.”

Nearly 25% of Americans live at least an hour from an Emergency Department that’s equipped to save lives in the event of a heart attack, stroke, bacterial bloodstream infection or major trauma.

To reach this conclusion, Brendan Carr and colleagues from the University of Pennsylvania School of Medicine queried the National Emergency Department Inventories–USA to identify the location and visit volume for all EDs in the country.

They estimated driving distances, driving speeds and population density, and measured ED access as the total population that could reach any particular ED within specified time intervals.

The scientists determined that 71% of Americans can access an ED within 30 minutes, and 98% can do so within an hour. But many of these facilities can’t handle the life-threatening stuff. Only high volume EDs are staffed, trained and equipped to do that.

In Montana for example, just 8% of the population resides within an hour of an ED that sees at least 3 patients per hour.
 
The write-up appears in the Annals of Emergency Medicine.

“Whether you are bleeding to death from an injury, having a heart attack or a stroke, the common denominator is time,” lead author Brendan Carr told BurrillReport.

The assistant professor of Emergency Medicine and Epidemiology added “in life-threatening emergencies, we must rely upon the system to deliver us to the care that we need.”

“If we knew what services were provided where, we could design a system that would do that everywhere in the country.”
 
The scientists suggest EMTs should be empowered to bypass the closest hospital in lieu of facilities better equipped to handle appropriately sick patients, ED facilities at rural hospitals should be beefed up, and incentives should be offered for physicians to practice in remote locations.