2009-11-19 / News

Islanders question experts at health care reform forum

By Phil Zahodiakin

An island church last week provided a platform for health care experts to examine the American health care crisis – and review the legislative “solutions” proposed on Capitol Hill.

The Nov. 12 forum was the first in what will be a series of “community conversations” hosted by Jamestown’s Central Baptist Church, which decided to create a stage for such debates because “we felt there weren’t many places in Jamestown for discourse on the important issues of the day,” Rev. Kathryn Palen, the church’s pastor, told the Press.

Palen, who said the next of the forums would be held after the holidays, said, “We chose health care for the first one because it’s on the minds of so many people.”

If the number of written questions submitted to the expert panel was any indication, health care reform is certainly on the minds of many island residents.

Michael Fine, a physician and director of HealthAccessRI – a statewide network of family practices providing affordable care to people without employerprovided insurance – said U.S. healthcare “might be considered a miserable failure.”

But the experts didn’t focus solely on health care problems. They also identified major changes necessary to repair those problems. In fact, one message that emerged from the Q&A and expert presentations is that none of the bills proposed by U.S. lawmakers is really about health care reform; rather, the bills are about health insurance reform.

That is a big mistake, the experts agreed.

“The fundamental problem with our health care system is that we don’t have a system,” said Lou Giancola, president and chief executive officer of South County Hospital, adding that “what we have is a free market system [with] 18 percent of the population uninsured. That’s a travesty. In the ‘60’s, people in the public health service said health care was a right. We’ve lost that.”

Fine said it’s imperative to devise “a national primary care system for all Americans. Primary care costs $300 to $400 a year per person, and it leverages data. All the nations with primary care systems have lower costs and better outcomes – and we’re spending far more money than anyone else.”

Leveraging, or sharing, data is an obvious way to reduce administrative expenses, which eat up an estimated 20 percent of all health care expenditures.

“If we don’t slow the growth of costs, we’ll be right back where we started,” Giancola said, adding, “Unfortunately, there’s little in the current proposal to slow that growth.”

Christine Ferguson, a research professor at George Washington University’s School of Public Health – and a former director of Rhode Island’s Department of Public Services – said the crisis in primary care has reached the point where, in some cities, “primary care physicians are refusing any additional patients unless they subscribe to a ‘concierge service’” – which guarantees access to the physicians, but costs tens of thousands of dollars.

All three panelists offered predictions about the future of the 2009 health care bill, but Ferguson stressed that health care reform would proceed, to some extent, regardless of the legislative outcome.

“When I started in health care back in the early ‘80s, prenatal care and delivery weren’t covered by any medical insurance – public or private. That wouldn’t be conceivable today, but changes like that have come about gradually and they will continue to occur – they just won’t be as noticeable as they would be if they were in a big, dramatic bill,” she said.

Questions posed by audience members included:

Q: What is driving up the cost of health care 10% a year?

A: Giancola attributed the steady jumps to increasing demand for chronic disease management, and “overcapacity” in – and over-reliance on – the newest technologies, such as MRIs. Ferguson added that the number and variety of available medications has skyrocketed in the last 30 years, whereas Fine ascribed much of the increase to a culture in which “we’re consuming tremendous amounts of high-fructose corn syrup and exercising much less than we should.”

Q: Why are car insurance premiums typically increased if motorists pile up tickets, whereas health care policies are sometimes canceled if policyholders develop major illnesses?

A: This reality “has snuck into our way of thinking and it’s wrecking our country,” said Fine, who questioned the salary levels enjoyed by “doctors and administrative people.” But Ferguson pushed back, asking why people pursuing a health care career shouldn’t “expect to make a good living.” Giancola blamed the disturbing trend on the “Wall Street focus” of private insurance companies, adding, “We have to get away from looking at health care as just another way to enrich stockholders.”

Q: Are there enough doctors to meet demand for primary care?

A: Fine said, “No, we are far short, but the proposed bill would at least provide $8 billion for community health centers, and that will improve the situation because those facilities are our safety net.”

Turning their attention to Rhode Island, all of the experts lamented the decline of health care coverage in the state.

“At one point, we ranked first in insured kids and second in insured people, but now we’re in the middle of the pack,” Ferguson said.

Fine added that Rhode Island “used to be considered one of the most innovative states in U.S. health care, and we can innovate, again. Our next gubernatorial election is crucial for our health care – regardless of what happens in Congress – because health care is 30 percent of the state budget. Like it or not, the next Rhode Island governor will have to be a ‘health care governor.’”

Giancola urged everyone interested in learning about state efforts to reform health care to visit www.rihealthright.org.

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