Local medical leaders are closely watching health-care reform legislation developing in Washington. While most agree with the importance of providing affordable options to the estimated 45 million to 50 million uninsured Americans, they have different views on how the insurance should be structured and what additional changes should be addressed.
“The question is: How are we going to pay for that expanded coverage?” said Scott Becker, president and chief executive officer of Conemaugh Health System. “The real interesting debate is going to be how far do they go with this public option. The key is how the benefits package is shaped.” Answers to those questions could change the structure of how health insurance is delivered in the United States, Becker said.
The public option, or government-sponsored health care plan, would be available as an option along with private insurance company plans, Democratic Sen. Robert P. Casey Jr. said during a teleconference announcing one of the bills had been approved by committee and sent to the full Senate.
In the Health, Education, Labor and Pension committee’s bill, the public option is a gateway to getting access, Casey said, adding it is expected many would move on to traditional private plans. But the public option is crucial to controlling costs. “I believe big, powerful insurance companies need to be held accountable.” Casey said. Under the committee’s bill, the gateway program would be launched with federal money but managed by a nonprofit cooperative, he said. “It’s meant to be a self-sustaining entity that can be competitive in the marketplace,” Casey said.
While any government-funded health insurance is meeting stiff opposition from Republicans, none of the local experts interviewed was ready to totally dismiss the idea. “I think the good thing is we are trying to develop coverage for 45 million people who don’t have insurance”, Becker said. “It is going to create a level playing field, but you are not going to get that for nothing.”
The final structure of a new public option will be developed after both the House and Senate pass bills and they are sent for reconciliation. Until then, Conemaugh is taking a wait-and-see attitude. “As they say: The devil is in the details,” he said. Lack of details has many in the insurance industry worried, Highmark spokesman Michael Weinstein said. Government insurance plans such as Medicare and Medicaid have traditionally paid physicians and hospitals less than private companies.
“There is a natural advantage to government-run plans: They dictate the payments to doctors and hospitals,” Weinstein said. “It is going to drive up the cost.” If the government-funded plan does not pay enough to cover expenses for hospitals and doctors, he said, the medical organizations will shift those costs to private plans such as Highmark. As those rates go up, insurance companies fear more employers will drop private plans and put their workers into the government plan. Bringing down costs must be part of any plan. Highmark supports a plan that would base payments more on outcomes, Weinstein said. “We haven’t seen enough debate on this: How doctors and hospitals are paid,” he said. “The way Medicare works, the more tests a patient has, the higher the cost. It doesn’t guarantee better outcomes.”
Some local preventive medicine advocates agreed that reform should include restructuring the way doctors and hospitals are reimbursed. “The good thing about the discussion is we are going to look at policy change,” Dr. Matthew Masiello, chief wellness officer, said from Windber Research Institute. “It opens up the doors with universal health care to look at policy we have not dared address in a serious way before. ”Smoking, obesity and nutrition can be addressed by adding financial incentives for physicians who direct patients into programs that help them overcome unhealthy habits”. Although Casey said his committee’s bill addresses preventive medicine and wellness, Masiello says all the proposed reform falls short.
“I see very little in there to support developing a substantial health-promotion, disease-prevention infrastructure,” Masiello said. “For that reason we are going to see higher cost of health care until we develop significant infrastructure.” Adding 45 million to 50 million people to the insured “pool” will be expensive, especially because many of those uninsured have chronic conditions that may be undiagnosed because they haven’t been seeing doctors.
Windber Research Institute is part of a study using electronic medical records to identify patients with unhealthy behavior and direct them into intervention programs. “Those kind of things should be on the front burner,” Masiello said. “Down the road you are going to get the results that will allow a reduction in the cost of health care.” The research institute’s top dog is more blunt. “This isn’t health-care reform,” said Tom Kurtz, Windber’s president and chief executive officer. “It is misnamed. They are going after an insurance product.” The 45 million or more people are just a symptom of a larger issue, he said. “It addresses nothing of the underlying problems of the health-care system.” Kurtz said, adding it might even be time to ask why the U.S. health insurance structure is based on employers. Recent layoffs highlighted the issue. “They need to revamp the system,” Kurtz said. “No one has even addressed the basic questions: Is health care a right? Is it an entitlement? What should be covered?”
Other countries have addressed many of these issues successfully, he said, adding “Japan is a good example.” But it’s tough to legislate behavior, Becker warns. Insurance companies could, however, charge higher premiums for those with greater health risks.
For now, Congress and the health-care industry should look at focusing on improving access to primary care doctors, Becker said. The current system pushes more money toward specialists, but family physicians are the front line of prevention. “It’s a cultural challenge we face now,” Becker said. “We need to open up roads and create incentives for more physicians to go into primary care.” Like his former Windber colleagues, health-care consultant F. Nicholas Jacobs believes the reform does not go far enough. “Tort reform, intelligent efforts toward stemming the continued surge of illegal aliens, a wellness rather than a sickness reimbursement system, acceptance of hospice and palliative care for end-of-life care, electronic medical records and new efforts to bolster our medical school attendance are just a few of the changes needed to allow health-care reform to gain meaningful traction,” Jacobs said in a statement.
The former president and chief executive officer of both Windber Research Institute and Windber Medical Center worries that current proposals have been watered down too much to appease conservatives and others. “Health reform is critical,” Jacobs wrote.
“But meaningful, ethical leadership is much more critical and both seem to have been on life support for a very long time.”
**This article was published in the Tribune Democrat on July 19, 2009
http://tribune-democrat.com/local/x914502174/Local-experts-weigh-in-on-health-care-reform
Never before have I come so close to abandoning my right and privilege to vote. The level of disdain, frustration and sadness I and so many others have with our political system has now surpassed the same feelings many have for our educational and health systems.
We see too often on the news the very worst of bullying; stories only told when a violent act or a suicide takes place. And, these violent acts may be just that, examples of violence which may or may not be consistent with the accepted definition of bullying. There are countless untold stories of bullying that happen every single day to thousands of children.
In 2009, international health experts arrived at Windber, PA, to lend us some of their expertise. We heard and discussed how we as a community; how we in our hospital systems can improve the health outcomes of our citizens and community. Those in attendance were clinicians, nurses, academicians, scientists, managed care executives, information technology specialists and an executive pharmaceutical team from NY. The one comment most of these folks made as the session was winding down and finally came to an end was how exhausted they were. Can you imagine having your world turned upside down on such issues as universal health care? Or this new terminology called clinical health promotion serving as the proven, evidence based approach to not only improving the health of our patients, but assuring us of better chance of getting out of the hospital quicker and with fewer complications.
Matt Masiello, M.D., MPH 