South Florida Hospital News
Monday August 19, 2019

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April 2005 - Volume 1 - Issue 9




Can We Have a Healthcare System That is Available and Affordable Without the Government Running It?

President Bush in a recent appearance at The Cleveland Clinic in Ohio, asked the following question: "The fundamental question facing the country is, ‘Can we have a healthcare system that is available and affordable without the federal government running it?’"

South Florida Hospital News asked leaders in our community to respond to this question. We have also included responses that we received for our sister publications, Western Pennsylvania Hospital News and Chicago Hospital News.

Marvin O’Quinn
President & CEO
Jackson Health System

I believe a healthcare system can be developed that is more available and affordable without being run by the federal government. In the past 20 years, the government has launched a number of cost-saving initiatives, such as DRGs and managed care. But costs have continued to rise, due to advances in technology, an aging population, and a high demand for intensive healthcare services right to the very end of life. While those factors are unlikely to change, we can slow down the rate of increase, while making healthcare services more available as well.

"The answer is for the private sector, in combination with state and federal governments, to provide significantly greater incentives for the utilization of primary care, wellness and disease prevention services. We know that primary care services are far less expensive to deliver than hospital-based services, and that they reduce the risk of hospitalization. If every American had a medical home with a primary care provider, access to healthcare would be improved and overall costs would be reduced. But that is not likely to happen without incentives encouraging greater utilization of primary care services. The next change that would reduce cost and likely improve overall quality of care is the return to Vertically Integrated Delivery system with incentives to be responsible for the health of an identified population. This structure would reduce the level of fragmentation that exist in our system and promote continuity of care.

Alan Channing
President and Chief Executive Officer
Sinai Health System

One of the most important roles that government plays in our society is to make available essential services that the private sector has neither the desire nor the resources to provide. In areas such as education, housing, recreation, infrastructure, and public safety, the United States has a hybrid of public and private programs.

Health care is no different from these other essential services. Ideally, a health care system should meet four criteria. It should be accessible, available, meet quality care standards, and be cost sensitive. Our privately funded system does a fine job of meeting the first three criteria for individuals and families who are employed with enough income to afford private insurance or are healthy enough to be able to purchase insurance themselves. Hospitals and physicians are plentiful in communities where most of the residents have private health insurance. Controlling costs remains a challenge to both the public and private health care sectors.

Where the private health care system of both coverage and resources fails is for those who fall outside this group. Despite the fact that the United States spends over 14% of its GNP on health care, over 40 million individuals are without health insurance. These individuals whose numbers grow each year are not served well by a private system alone. Those with chronic or past health problems who cannot purchase affordable insurance are cared for by a mixture of public and private services. Low-income patients whose care is sponsored by Medicaid are often not desirable patients for many private health care providers because of low reimbursement rates. This is especially true for physicians who are paid at a rate below their costs.

At Sinai Health System, we are acutely aware of the need for government programs to fill the gaps left by the private system. Sinai is the largest provider of heath care to low-income patients in Illinois. In partnership with Access Community Health Network, a system of federally qualified community health centers, we provide primary, acute, specialty and rehabilitation care to over 200,000 individuals. Over 60% of Sinai’s patients are sponsored by Medicaid. Another 10% are without any insurance coverage. An additional 20% are enrolled in one of government’s great health care success stories, the Medicare program. Only 10% of our patients have any private coverage. Government support of disproportionate share hospitals and federally qualified health centers is critical to maintaining accessibility and availability of care for these communities. No private resources are available that can meet these need.

However, the current level of government support will not be sufficient to continue to provide a safety net in low-income communities. Specialty care remains poorly paid, and maintaining access to quality specialty services is an issue the government will have to address. Most safety-net providers have been unable to fund the capital improvements needed to provide cost-effective care in a contemporary setting. The growing numbers of uninsured and underinsured patients are placing an increasing financial strain on safety net providers. For these patients and communities, the issue is not who "runs" the system but where the resources come from to offer available, accessible, quality, and cost-effective care. These resources can only come from government.

Arthur E. Palamara, M.D.
Hollywood, Florida

A 2004 publication of the AMA showed that national healthcare expenditures in 2003 totaled approximately $1.5 trillion. Those actually involved with patient care - hospitals, doctors and pharmaceuticals - accounted for $1 trillion of the total. The remaining $500 billion was lost to entropy - consumed by administration and corporate profit. This is a sum patients can ill afford with healthcare premiums spiraling out of control and 45 million uninsured. When the private sector fails to satisfy societal need, the remaining remedy is left to government.

Robert E. Fisher, CHE, FHFMA
President and CEO
Brookville Hospital

There is a public misconception that we have a health care "system" when what we really have at the present is a series of cottage businesses loosely tied together. We are not even nearly as coordinated as the US banking industry. Since revenues are so tightly controlled by the government and large health insurers, to make an available and affordable health care system will require the federal government to either take over all health care operations, or to provide the funding for new information systems so we can afford to provide electronic medical records and make them available to all parts of the "system" similar to the banks’ ATM system. Only then could we be in a position to take out enough unnecessary cost and have information transferred to make health care more affordable and available. Unlike other businesses, competition in health care doesn’t reduce costs but increases them, with the proliferation of diagnostic services (MRI, etc.) as a prime example. Unless we have either some rational health planning, or a government take-over in the near future, I’m fearful that our "system" is destined to fall under its own weight. Call me a pessimist, but I truly believe that health care needs to be run like a public utility at the very least or by the government if all else fails.

Bernard J. Kerr, Jr., EdD, FACHE
Associate Professor
Doctor of Health Administration Program
Herbert H. and Grace A. Dow College of Health Professions
Central Michigan University

The answer is Yes! Any high school debate team member armed with a modicum of Internet research could argue for or against the creation of a federal healthcare system. The debate would not be won or lost on the merits of the concept, but on the emotions and the politics of those judging the debate. This debate has raged for decades and the nation remains without a clear commitment to an enlightened and well-defined healthcare domestic policy. Pontiffs, consultants, panels, committees, special interest groups, elected officials, healthcare professionals and consumers all debate having a federal health care system from their various points of view. All the while, the healthcare system, or as some like to say the non-system, continues to evolve as it is pushed, pulled, punched and punished; but never led in a strategically prudent direction. The federal government should provide leadership, not lobby to "run" the system.

Healthcare is a service that is not as distinctly different from other services as many would suggest. Continued attempts to differentiate healthcare as being a substantially unique service have created a false premise. The widely embraced belief is that healthcare is so different from other services that basic economic principles do not apply. This unfounded notion has helped fuel interest in creating some form of federal healthcare system. Given the lessons learned from Medicare and Medicaid, one would think furthering the government’s role in healthcare would be a very hard sell. Sadly, those who would promote the creation of a government run health system have many allies. Why? Because discussions of healthcare access and cost are largely emotional or political rather than factual and rational. It’s easier to argue health care is "different" and it’s generally unpopular to suggest health care is a service not unlike many other personal services.

I have no doubt private enterprise, unencumbered by regulatory constraints; can consistently deliver products or services at a better value-rated cost than the federal government. This value-rating would be a balanced combination of measurable outcomes focusing on quality, availability and cost. Does anyone doubt that the U.S. Postal Service mission could be efficiently and effectively accomplished by a non-government company? There might be changes in the service, like no more Saturday delivery. Would that denigrate overall postal service quality, or potentially enhance weekday service? Our postage stamps might advertise a soft drink instead of being adorned with a picture of Elvis. Might that help contain the cost of a first class stamp? The post office might not be open on Saturday any more, but could instead offer evening hours on weekdays. Wouldn’t that favorably impact access? Absent the privatization of the U.S. Postal Service, we’ll never know the answers to these questions because the federal postal system does not respond to the same market and economic influence that a private, for-profit postal system would. Nor will we ever explore how successful a not-for-profit privately-held postal service might be.

There are meaningful and essential roles the federal government can and should play in the delivery of healthcare to selected groups who might otherwise be disenfranchised from reasonable levels of care. However, the wholesale federalization of America’s healthcare system is not the best solution for assuring access and affordability. The healthcare system that has evolved in America is a somewhat flawed but magnificently impressive service delivery machine. What that machine needs is for emotion and politics to stand aside and allow the basic tenets of free enterprise, capitalism and not-for-profit altruism to take the lead. Putting an end to the debate over the merits of a federal healthcare system run by the government would be an excellent place to start.

Margaret A. Davis RN MSN FNP
Executive Director of the Healthcare Consortium of Illinois

We can not have a healthcare system without federal government involvement. Our premise is based on the fact that we do not have full employment, which makes it impossible for all residents to have access to quality healthcare. Based on this argument, it would prove detrimental to have a healthcare system without the federal government’s involvement. Furthermore, many who ARE employed lack health insurance. A recent report notes a high percentage of bankruptcy cases occur after hospitalization, which resulted in high medical bills the patient is unable to pay. In order to have full access to healthcare, we need FULL employment – as a foundation. The Government can NOT step out until we have full employment and access to quality healthcare.

Thomas White
President & CEO
Jameson Health System

I do not feel we as a nation require the federal government taking over the health care system.

I believe we must take a very serious look at our present system and move for significant reform. We must change our continued approach of treating illness and begin to concentrate on eliminating the causes of illness, disease, and other threats to the health of our society. In order to do this, we must institute a serious national program of wellness and prevention, as well as eliminate excesses in our society. This, of course, will require behavioral and societal change and a commitment to that change by individuals as well as the health care providers, payers, and government.

We must make people more responsible for their health and welfare. We must provide health education at the earliest age possible, and we must monitor an individual’s behavior as it relates to health. If individuals are not adopting and maintaining a healthy lifestyle, they should be required to share more of the financial burden for the cost of their care. We must provide incentives for people to be healthy, and we must reward them if they are by reducing their health care costs.

We must also reform the payment system to ensure access and affordable health care to all. We must pay for prevention and wellness. We must not pay for duplication and convenient services. We must reduce the unfettered demand for all health care services by adjusting payments for medical necessity services and not subsidizing unnecessary service or care. Hospitals and physicians, as well as other providers, must join together to manage care and make certain that the right care is administered by the right provider, at the right location, and for the right price.

If we do this, we will have an affordable, accessible, and quality health care system for the citizens of our county.

Ken Garver, Administrator
Jameson Care Center

I never thought that I would come to this opinion, but after studying our health system for almost 27 years, it would appear that the only way for all citizens in this country to be adequately serviced with healthcare, is to follow a more socialistic model such as exists in some European countries like the Netherlands. Unless the Government takes over, the for-profit system will continue to promote various self interests in lieu of universal coverage. In the richest nation on earth, 40 plus % of Americans without health insurance is a crime.

Sister Donna Marie Wolowicki, C.R.
Executive Vice President and CEO
Resurrection Medical Center, Chicago, and
Holy Family Medical Center, Des Plaines

In a recent appearance at the Cleveland Clinic in Ohio, President Bush posed the question: There is no question that access to healthcare in the United States is a serious and escalating problem. Recent statistics indicate that more than 41 million people are without health insurance. However, I do not believe that the answer to healthcare access will be found in delegating full responsibility to the federal government.

The answer to healthcare delivery and healthcare costs, I believe, will not be accomplished by any single entity. The only way a lasting, democratic, and respectful solution will be accomplished is by shared responsibility and cooperation involving individuals, communities, healthcare providers, third party payers and government. These five parties must work together to develop realistic expectations of healthcare, reasonable and ethical guidelines for the utilization of resources, financial mechanisms to support the system and provision of routine baseline health maintenance and illness prevention programs. Our current delivery system often wastes resources at both ends of the spectrum. Many payers do not cover screening programs, health education and wellness programs. The uninsured need to have access to routine healthcare, medication and illness prevention. Failure to cover these lower end costs lead to human suffering and utilization of more expensive emergency and hospitalization services.

The federal government can assist with financial coverage of these programs but it is the local communities, local government and local healthcare facilities which can best identify and meet the needs of the uninsured in their area.

At the other end of the spectrum, physicians and other healthcare providers need to work proactively with patients and families to plan for appropriate and realistic long term care needs before a crisis strikes. Families often do not discuss beforehand the possible need and choices for long term care facilities or home care. Then when a crisis strikes, it leads to long and expensive hospital stays and the utilization of resources far beyond what is appropriate.

We need the cooperation of individuals, government, communities, healthcare providers and third party payers in order to design a healthcare system that is not only fiscally responsible but also compassionate, committed to excellence and as concerned with wellness as it is with illness. No one needs to take over but everyone needs to step up and take part in the solution.

Senator Rick Santorum (R-PA)
Chairman, Senate Republican Conference

In recent years, Americans have experienced an alarming trend of steady increases in the cost of quality medical care and healthcare coverage. Therefore, it is fitting for Hospital News to question what role the federal government should play in addressing the cost of health care. The number of citizens who cannot afford adequate health care remains unacceptably high, and failure to address these trends could cause serious damage not only to the health of individual Americans, but our nation’s economic health as well.

I am strongly opposed to a system that would create a single-payer healthcare system run exclusively by the federal government. Such a system would undoubtedly lower the quality of care that Americans enjoy. In Canada’s single-payer system, for example, patients requiring many types of surgery must sit on waiting lists for months while their conditions worsen.

Furthermore, without the beneficial effects of competition among health insurers, or the effective cost-cutting measures developed by the private sector, I am concerned that a government health care monopoly could lead to higher prices and create an even greater burden on taxpayers. One need only look at the numerous archaic, confusing, and inaccurate formulas Medicare and Medicaid use to determine physician and hospital reimbursements to appreciate the ramifications of adopting a universal, government-run health care system.

Instead, the key to an affordable, efficient, and comprehensive healthcare system is one driven by competition and consumer choice. By expanding public-private partnerships that utilize the greater efficiency and existing infrastructure of private insurers, we can ensure that all Pennsylvanians have access to quality and affordable health care and expand health coverage to the uninsured. Additionally, competition ensures that patients are receiving the highest quality of care and services, including advanced therapies as a result of innovative research.

As the son of a psychologist and a nurse, and the husband of a nurse, I can personally say that government run health care is not the answer to what ails our healthcare system. Government should facilitate competition that allows all patients to benefit through tax incentives, competitive grants, and educating consumers and patients about their healthcare options. The role of government should be to help create the atmosphere in which a healthcare system can thrive and bring stability to America’s medical expenditures.

Given the manifold reasons for the increasing costs of health care and health insurance, other structural changes to America’s healthcare system will have to be made if we are to truly bring stability to Americans’ medical expenditures. The medical liability crisis, for instance, which stems from disproportionate jury awards in medical malpractice lawsuits and excessive medical liability insurance premiums shouldered by physicians, raises the costs of providing medical care and has led many physicians to retire early or severely restrict the scope of their practices to reduce their premiums. Pennsylvania has been particularly hard hit by such trends.

Another major reason for the high cost of medical care is excessive government regulations and mandates placed on the healthcare industry. These regulations and mandates can have unintended negative consequences, sometimes making healthcare problems worse. When the federal or state government mandates that insurers cover a particular treatment or condition, beneficiaries’ premiums rise in response to the additional costs incurred by their insurer. At a time when soaring premiums are pricing health insurance coverage out of reach for many Americans and small businesses, it makes no sense to pursue additional coverage mandates, no matter how well intentioned they may seem. Unfortunately, additional mandates are constantly proposed. The total number of federal and state mandates combined is already over 1,400. The federal government should maintain a balance between promoting fairness in health insurance coverage while not passing on costly mandates that will only increase the number of uninsured.

Therefore, with the necessary steps, Congress can make health care more affordable and accessible by creating an atmosphere of competition, enhancing public-private partnerships, curtailing the cost of excessive awards in medical liability lawsuits by capping non-economic damages, and reducing federal regulations and mandates placed on the healthcare industry. A federally run healthcare system is not the answer.

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