The fate of health care reform remains undecided. Discourse on the issue rages throughout the nation. One thing is clear. There are more questions than answers. Below is an op-ed that I have written on our position. It was published August 13 in the Queens Chronicle, a community newspaper spanning the neighborhoods of Queens. The concerns of community teaching hospitals, like ours, play a major part in the reform debate. Our President and lawmakers must consider the delicate balancing act hospitals endure to bring health care to our communities.
Stephen S. Mills, F.A.C.H.E.
Health Care Reform in America and On Main Street
by Stephen S. Mills (as appeared in Queens Chronicle, August 13, 2009)
Health care reform has a chance to positively influence access for all Americans and to streamline the process of reimbursement to health care facilities and physicians, at an affordable cost— through savings, better quality, and appropriate utilization.
President Obama is driven to accomplish this reform, something that presidents have been after for decades. Success will be measured within the reality of politics for insuring those without coverage, and with incentives to cover preventive care and care for chronic disease.
The time is right. The President is determined and that is key to making it happen. However, until there is a definitive plan and every sector of the health care army commits to sacrifice to make it a reality, reform remains undefined and unfunded.
The core issue at hand is two-fold. First, why is health care reform necessary? How will it provide value (cost vs. benefit)?
Talk about a health insurance “exchange” is amorphous. The issue of the uninsured is well known; thus a specific plan to mitigate this is essential. As time passes, unemployment wipes out family resources, including employer-provided health insurance. We have to consider the many who have health insurance— employer sponsored or individual plans. For them, not only have premiums risen at double-digit rates over the past few years, but also high deductibles and co-insurance per episode are onerous to middle class people, which results in postponing necessary care. So, what will be the plan to make these out-of-pocket expenses manageable?
Without some cap on malpractice awards and/or rudimentary reform, huge financial burdens are placed on physicians and on health care institutions that simply are not sustainable. As physicians are leaving practice; hospitals and nursing homes cannot provide the spectrum of services the community requires.
Hospitals, nursing homes, physicians, and insurance companies are plagued with over-head costs, employing masses of people to “manage” necessary insurance authorizations, process-denied hospital stays and physician visits, billing errors, coding and medical record documentation, accounts receivable and complex follow-up issues. Hundreds of millions of dollars are spent (and ever-increasing amounts will be spent) to support this bloated bureaucracy.
The President is looking to Congress to develop the plan. Amid politics and big money lobbyists, Congress needs to understand the importance of extending the right to health care to all— and the necessity of shared sacrifice in order to achieve it. The American public, including Congress itself and special interests, the private insurance companies, the pharmaceutical and hospital industries and physicians, some which have already anted-up some sizeable dollars, all need to play a part in reform that adds value.
Within the discussion of how to pay for it, we believe that taxing those citizens most able to afford it is acceptable. Increasing taxes to the middle class is not. They cannot take on more financial burden to gain and keep access to care.
Quality enhancements can and should cost less. Primary and preventive care, patient safety initiatives and accurate and timely information are just some of the enhancements that we know pay off for people and for “the system.”
In summary, a specific proposed plan, with clear, long-term funding sources is essential. The elements have to include broad coverage, incentives for U.S. industry to be able to compete in a world economy on a level playing field with international companies that do not have the uncertain and growing burden of paying for healthcare as we do in this country. Individuals with health issues are not denied coverage or dropped from the insured category. Out-of-pocket costs, not just for premiums but the onerous and growing deductibles and co- insurance dollars are mitigated and predictable. Lastly, the element of choice of plans and coverage is integral.
In order to get to the goal of true, value-based reform, all parties in the health care industry must sacrifice something to afford what should be an advantage to all. If value is not perceived, we will once again miss an opportunity. Without a specific plan, no one can buy into just a concept.