Thursday, April 8, 2010

Fix Health Care, Don’t Destroy it.

This is something I wrote just before the Congress voted to pass the health care reform bill. It ran in the local Alliance newspaper and I wanted to share it more globally.

Everyone agrees the current Health Care System is broken.

It is dying and without reform will be financially
unsustainable in 6 to 8 years, but it AIN’T DEAD YET! It
can be fixed, but the current bill being considered is not
the answer.

In earlier blogs last Fall I wrote I came away encouraged
after going to hear President Obama speak on health care
reform and I wanted the change process to begin as quickly
as possible.

Why? I believed it would take an extraordinary
effort and everyone working together over the next six
years to keep it from dying. I must admit I was terribly
naïve to think that our elected leadership (both Democratic
and Republican) could actually work together on something
so vital to our economy and our well being. Sadly, it seems
that there is some type of epidemic infecting our leaders
upon arrival to their offices in Washington D.C.; instead
of trying to work together to bring about change
benefitting everyone, the current process seems to be more
about posturing and manipulating who may get elected or
kicked out of office.

Most of the national media hasn’t
helped much either; instead of helping understand what is
broken and the merits and consequences of needed changes,
they too are focused on how it affects political fortunes.
I am ticked off and feel helpless. I am only one vote and
one voice and admittedly biased... but I love our
healthcare system-there are too many of us –doctors,
nurses, volunteers, and healthcare workers who really care
and are wonderful at caring for people. Before you end up
with health care you will not recognize, you will not like,
and health care that over time you will not be able to
afford as a taxpayer, I need to speak out.

Today’s healthcare system is a combination of private
not-for-profit (the majority of hospitals in the country),
governmental, e.g. VA hospitals, Federally Qualified Health
Clinics, and County Hospitals etc, and private for–profit
Hospitals or individual practicing physicians and nursing
homes. I believe most Americans would choose to have their
care in the USA rather than go to another country, even if
their health care funds were unlimited. As imperfect as
this system is, people have more access to care in this
country than anywhere on the planet. The major problem is
how it is financed and how care is paid for, and who can
pay. All I know is Americans have some of the biggest
caring hearts and we usually are at our best when
responding to a crisis and challenge. We have a tradition
of helping those that couldn’t help themselves, whether it
is peace keeping, natural disasters or large challenges
here at home, like the crisis in health care. The
healthcare system is in crisis and what we need now are
leaders and statesmen, not political solutions.

The “political fix” (tampering with a very complicated
system that is about to happen in Congress) will be far
worse than doing nothing. The current system is still
fixable but you can’t fix something if you kill it, which
the present bill will do. We do need government
intervention because “we” that are all part of the system
need a target and direction. This should be our
government’s role in my opinion.

What are we about to destroy? Well in Ohio the healthcare
system represents about $66 Billion of the Ohio Economy and
hundreds of thousands of jobs. One of the greatest “safety
nets” for those who can’t afford to take care of themselves
are not-for- profit community hospitals. In Ohio we
provide just under $4 Billion of care to those that can’t
afford it.

For simplicity let’s address the three major points of the
current health care bill now being considered:

1) You can’t be denied coverage if you have a pre existing
condition(I am actually very much in favor of this,
just concerned with how it will be implemented).

2) Everyone will have coverage.

3) A lot of money will be taken away from the private and
not for profit insurance companies by the government
not reimbursing them as much (roughly $500 billion). In
return, the insurances companies will turn around and
pay less to the providers (doctors and hospitals) for
senior’s health care.

So how do I see this playing out for a Community Hospital
like the one I practice at (similar to about 3000 other
Community Hospitals in the USA)?

1. People with pre-existing conditions can’t be denied
coverage? Does this bill really address how to properly
afford this not only for tax payers, but for people who
keep their current insurance like President Obama said they
could? The way it is structured in the current bill under
consideration will cause all insurance companies to build
in additional premiums to cover pre-existing
conditions—your insurance costs or taxes will go up. How
will all these plans and a government rate commission pay
hospitals and doctors—I can only guess as it appears to be
a secret. Today our hospital is paid only part of our costs
(Medicare pays us about 89 cents out of every dollar of
costs and Medicaid pays us about 78 cents of our costs).
The impact we assume will have to be more increases in
price shifting to those individuals with any type of
employer or private insurance. Again, the premiums for
those with this type of insurance will have to go up. This
will also cause more administrative costs for insurance
companies. Many community hospitals will be left with no
bottom line which means less safety net care and more job

2. Everyone has coverage. The same patients will be coming
to our hospital as do now. Does this mean less people
coming to our Emergency room for care? Will more doctors be
opening their practices to more patients?
Presently, we have a federally qualified health clinic in
our community which offers free primary care or a sliding
scale of payments based on what patients can afford. So
why do so many more people come to the emergency room for
care? You don’t have to make an appointment and you don’t
have to provide financial proof to determine what you will
pay. You may have better access to a specialist and you can
still sue (most people don’t, but try suing the federal
government clinic.) I don’t mean to be cynical but only
make another point. One of the reasons ER care is so
expensive is to be able to defend lawsuits that you did
everything that was appropriate; you don’t get sued for
usually doing too much, although you may get denied
payment. Bottom line, in my opinion, is more people will
be coming for care in the ER, which is more expensive. Why
isn’t the federal government fixing the problems with these
clinics if there is an access problem to primary care? The
public who have access to these free services still prefer
the private system. If you give them coverage with no more
reason to change going to the ER (which they prefer and is
easier to use) we have only encouraged more use. If the
hospitals were already providing much of the care through
the ERs, why not turn over the federally qualified health
clinics to be run by not-for-profit hospitals next to our
emergency rooms?

3. Take a lot of dollars away from the insurance companies
and force them to create an even more bureaucratic system,
and they will in turn cut payments to doctors and
hospitals. The insurance companies have billions at their
disposal and will not be hurt as severely as doctors and
hospitals. Doctors and hospitals, where profits are less
than insurance companies, will suffer far more. Doctors
and hospitals will take big hits and we now provide the
biggest safety net for those presently without healthcare.
I feel this proposed bill will kill the not -for- profit
hospitals and destroy the current safety net of providing
care for those that can’t afford it.

Final thoughts:
Why can’t a free market exist that is competitive and
encourage best practices of both hospitals and doctors?
There is little economic alignment between most hospitals
and doctors, most hospitals are at a tremendous
disadvantage in negotiating with insurance companies for
how we are paid–we don’t have the leverage. There is
virtually no real transparency (the patient does not know
the out of pocket expenses) on actual costs to health
consumers before they seek care. Where else would you buy
something and find out how much it costs later? Here is
where we could use government intervention and the best
ideas of all concerned.

The way we are paid doesn’t seem to allow for that. Paul
Levy, an administrator in Boston of Beth Israel Hospital
and the CEO of St. Lukes, who runs the most cost effective
hospital in Toledo, knows insurance companies set the price
and many hospitals are paid far less than others, even if
they provide the exact same service.
Insurance companies put in our contracts that we can’t
disclose the price they negotiate with us for services. Out
of pocket expenses are a much greater part of an
individual’s health expense today. How can consumers
actually shop and compare price? Doctors and hospitals can
compete and lower or bend the cost curve. We need a level
playing “field” and competition and transparency and
consumers with a stake in the game.

Medicare is not broken; most seniors I know appreciate it
and the care they receive. The funding mechanism is broken
and there are too many boomers who are looking forward to
Medicare (me included but they are already talking about
means testing and raising the age limit on eligibility).

There are pilot projects around the country to start
working on economic alignment between doctors and
hospitals. This has the potential for stimulating a free
market response to best practice. Why does it take the
government years to implement this...because it is a very
complicated system that is government run? I wish our
government leadership would follow this path to challenge
us in the system to compete with each other and redesign
our system. It would happen much quicker in the private

We need Leadership and Americans working together. We have
sent good people to Washington. Please STAND UP AND BE
HEARD. You represent us. For god’s sake and ours start
working together. We can’t afford for you not to!!
Please call your Congressman and tell them doing nothing is
not an option, tampering with a system without fully
understanding the consequences is far worse, so start
working together with the best ideas of those of us who
work in the system each and every day.

Stan W. Jonas
CEO of a Not-For-Profit Community Hospital
Alliance, Ohio

This Advertisement was paid for by Stan Jonas.
It expresses his personal opinions and not necessarily that
of the hospital, its doctors or staff.

Monday, April 5, 2010

April 5th

Last week I received a call from Eileen, a recent patient in our therapy department. The following words were used in her voice mail regarding her 16 trips for service: “very professional . . . everything was first rate . . . everyone was knowledgeable . . . if not for them, I wouldn’t be walking around and feeling good.”

I wanted to let our therapy department know that our patients are constantly calling in to express their thanks.

My thanks again to our team of dedicated colleagues for what you do each and every day.