South Florida Hospital News
Thursday August 6, 2020

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December 2006 - Volume 3 - Issue 6


Local Healthcare Administrators Vote 'Yes' on Universal Healthcare But Don't Envision it Happening Any Time Soon

For years, the federal government has been exploring various options to ensure that all Americans are able to receive healthcare. While everyone agrees on the need to provide health coverage, and although intentions have been good, no one has been able to come up with a plan for a program that's doable on a national scale. Last April, the Massachusetts legislature passed a landmark bill mandating that every resident of the state have health insurance coverage or pay a penalty. Since the law passed, it has spurred discussions among lawmakers, medical professionals and others in other states about the feasibility of similar laws in their own jurisdictions.

To get a sense of how or whether such a law might work in Florida, South Florida Hospital News spoke with several healthcare administrators. We asked them if they believed Florida should have a universal healthcare law and, if so, how it should be funded. We received a variety of responses.

Linda Quick, president of the South Florida Healthcare and Hospital Association (SFHHA), says there should be legislation to cover everyone across the state. However, she added that such an effort would run into several obstacles. "An individual mandate will not work," she said. "Funding it would be a key issue, since there's no state income tax--unlike other states, in which residents are in touch with the government once a year to file taxes, Massachusetts is one of those states. Outside of that, I can't imagine how you could make sure residents are covered."

She compares a possible universal health insurance initiative to the current auto insurance requirement that is in place in Florida. "That's mandated in Florida, and there are lots of people who are driving around with no coverage," she says. "Here, people tend to evade such requirements, and there are no 'insurance police' keeping tabs on them to make sure they maintain coverage."

Another important consideration, according to Quick, is the sheer population volume. She notes that, in Massachusetts, there are an estimated 500,000 uninsured residents statewide, compared to up to 500,000 uninsured in any one Florida county.

Alan Whiteman, PhD., FACMPE, agrees. As the associate dean for Health Sciences and director for the Master of Science and Health Services Administration at Barry University, universal health coverage is a topic to which he's given considerable thought. In fact, he noted that prior to the Massachusetts law, Hawaii was actually the first state to mandate universal health coverage. Also, prior to his current position, he was self-employed as a consultant to hospitals, medical schools and physician practices, so he knows firsthand how expensive health insurance coverage is.

"I do believe that everyone should have coverage," he says, "because providing free health care to the uninsured is a big burden on the system. But how would you pay for universal health coverage? That's the big issue." Like Quick, he notes the number of people who would need to be covered. "There are 18 million people in the state, and it's a very unique population mix, including large immigrant populations that don't know how to access the healthcare system."

Then, there are other related issues. "About 15 percent of the population is covered by Medicare," he says. "That's very significant in Florida. There are also a large percentage of small employers, as compared to other states, many of which have large, major companies. And from the standpoint of medical care, we've lost large numbers of physicians because of the malpractice crisis. Universal health coverage is a great idea--if we can figure out a way to finance it."

Arthur Palamara, M.D., brings a unique perspective to the discussion. A vascular surgeon and past president of the Broward County Medical Association, he recently ran unsuccessfully for the State House on a platform whose cornerstone was his plan for universal health coverage. He views his election defeat--and the fact that his plan hasn't been accepted--as a lack of willingness to change on the part of local constituents. "We need a plan, especially given the fact that the number of people with insurance is going down in Florida," he says. "Had I been elected, I would have addressed the issue. But no one here wants to change the status quo."

He believes the Massachusetts model is doable in Florida, but says the political will needs to be there to make it happen. "There are five key audiences that need to be willing to change--but none of them are," he says. "In large part, that's what's keeping a universal healthcare law from being enacted."

He goes on to explain. "First, insurance companies are making good profits, so they don't want to see the system destabilized. Second, coverage can only be purchased through insurance brokers, and they're making good money--six or seven percent off the top--and they don't want to change. Third, the chambers of commerce don't want to see any more surcharges imposed on their business members--many of whom are small businesses--so they won't likely support it. Fourth, hospitals are making money by raising their own rates to cover shortfalls. And last, consumers can only afford to pay so much."

In Palamara's healthcare plan, both employers and employees would make contributions and employers would get tax credits in return.

"My solution," he says, "requires a public-private partnership, since neither sector will be able to solve the dilemma alone. It incorporates aspects of the reforms now underway in Massachusetts, Maine and Hawaii. A major aspect of my plan relies heavily on primary care doctors, as did North Carolina's approach to Medicaid reform. It also questions futile end-of-life care, which is a challenge no politician wants to engage. Since one-third of our two trillion dollar annual health care budget goes to profit and administration, it calls for serious limits on profitability."

Palamara sent copies of his plan to a number of organizations, including Blue Cross/Blue Shield, Vista HMO, the Service Employees International Union, the AFL-CIO and the Florida Medical Association, as well as the Miami Herald and Ft. Lauderdale Sun-Sentinel. The editorial boards at both newspapers endorsed Palamara's candidacy for State House.

He notes that Medicaid Reform was passed in 2005 with strong pressure from Gov. Jeb Bush. "The law mandates that 177,000 Medicaid recipients--out of a total of 244,000--had to be enrolled an HMO or a Provider Service Network, or PSN, by July 1, 2006. This demonstration project currently includes only two counties--Broward, where I live, and Duval. Broward will receive roughly $1.5 billion. HMOs and the PSNs may enjoy up to a 20 percent profit."

He notes that most health care planners don't think that $1.5 billion is an adequate amount for meeting all the medical needs of the recipients. "They expect that Medicaid patients will become frustrated will hurdles imposed by HMOs and will use the hospitals and emergency rooms as providers of last resort," he says. "They expect this trend to increase."

This means, he believes, that hospitals will be forced to provide additional, but unfunded, services. "A large portion of services to the Medicaid population are provided by the North and South Hospital Districts, which together have nine hospitals," he continues. "They both have the ability to tax property owners. Hence, the burden of providing care will be increasingly assumed by tax payers."

Palamara is watching closely to see where things will go, but he would like to have played a legislative role in enacting reform. "Had I been elected, I would have organized a town-hall meeting of public and private providers to devise a solution," he says. "No single entity has the ability to solve the problem of the uninsureds."

Ronald Giffler, M.D., a pathologist and Immediate Past President of the Broward County Medical Association, has been watching the rollout of the Massachusetts program and is encouraged by it. "Since it's a new program, I would like to look at it for a year or so to see how it works," he says.

Like others who participated in this article, he mentioned the needs and challenges that are somewhat unique to Florida. "There are lots of small businesses here and a large number of uninsured people. I like the idea of making everyone contribute to the plan in some way, based on income level. Some people want a sweeping health plan run by the government; however, I think we should look at other innovative ways and approaches. "

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