2IHA remains focused on the key hospital provisions surrounding health care reform, but with the continuous news coverage about hot tempers at Congressional town hall forums and hospitals being major hubs for the provision of health care, IHA also maintains a vested interest in the topic of health care reform as a whole.
In recent weeks, as members of Congress have been addressing health care reform with their constituents many have erupted in a fury of misleading information and the emergence of new scare-tactics and buzz phrases like “death panels” that attempt to stall, stymie or completely derail progress on health care reform legislation. Some members of Congress are even participating in this misinformation campaign by handing out partisan propaganda and making claims that the House bill contains a provision that gives the government authority to “pull the plug on grandma.” (see previous IHA post on this subject)
Though the impact of these raucous town-halls remains to be seen, it certainly has caught the attention of the media and has started a public relations nightmare for Congress and the White House (that went so far as to launch its own “reality check” Web site).
Although much of the negative comments being said at these forums do not relate to specific hospital provisions in the bills/proposals, and a good debate is one that encourages multiple viewpoints, it’s also important to separate fact from fanatic.
There are many resources available on the Web that help to sort out the issues. The Kaiser Family Foundation has an entire Web site dedicated to health reform as does the Commonwealth Fund. There is also the aptly titled Factcheck.org that also has well researched answers to many of the health care reform questions, issues and myths.
It’s important to remember that health care is a complicated topic and cannot be explained or, for that matter, reformed in a few short sentences. It’s a major undertaking and requires a lengthy, but intelligent, debate.
As Mark Twain said, “it is wiser to find out than to suppose,” and that’s as true about health care reform as it is about anything from the overall concept down to the smallest details. Those that rely on misinformation will only help to create health care reform that is ineffective at best and damaging at worst. The more responsible approach includes getting the facts straight and working together to find solutions to make positive reforms that will improve how health care is delivered, how coverage is obtained and how it will all be paid for.
As I listen to the debate over healthcare reform, I hear a significant amount of exaggeration, misleading facts, and supposition (in Twain’s words) coming from all sectors including the healthcare industry itself.
Supposition /Exaggeration #1: Reform bills will end up pulling plug on grandma
Reality: Reform bills do create government agencies that will make decisions on benefits and coverages. (I note that it doesn’t appear hospitals are represented in these agencies or panels). Ultimately government bureaucrats will in all probability make decisions differently than we would make ourselves, although it is doubtful that a conscious decision to “pull the plug” would be made.
Supposition #2: Spending $billions on wellness and prevention will save enough money to fund reform
Reality: Wellness and prevention are great to pursue, but should not be the business of government mandates, and there is no evidence that wellness and prevention will save significant money. In fact, over the short run costs will increase if we spend funds on these activities that aren’t being spent now, and in the long run, if successful, people will live longer, and it is unrealistic to believe that they will not need healthcare as they age.
Supposition #3: Spending $billions on E H Rs will also save even more to help fund reform.
Reality: While E H Rs are wonderful and the concept of an efficient, working, user friendly E H R is even more wonderful, investment in E H Rs will be tremendously expensive in the short run and while they might prove convenient, might help to improve quality, and might provide some improvements in continuity of care, there is no evidence that they will save anywhere near their cost of implementation. Especially if providers are forced to implement E H Rs that exist today, which are not open architecture and have not already proven themselves financially worthy of adoption in the marketplace in the first place. In my hospital’s own example, we now spend about $100k annually for Information Systems and to attain “meaningful” use we will have to spend upwards of $700k annually. I would be more than interested in someone documenting for me where I will save $600k annually.
Supposition #4: There are currently 50 million uninsured/indigent Americans who do not have access to care.
Reality: The vast majority of these uninsured/indigent Americans do actually have access to healthcare, because most providers care for them without regard for being paid and commercial insurance premiums pay for a portion if not all of their care, and various agencies assist them with care.
Supposition #5: A government run public plan will save significant dollars and compete fairly with private insurance allowing current consumers to retain their current health plans. The currently uninsured will be provided with some means of gaining public plan coverage relieving providers from caring for the indigent.
Reality: Current examples of government managed health plans (Medicare & Medicaid) have been tremendously effective at providing access to care, but are complete failures at reducing or containing costs, and are one of if not the primary reason commercial insurance plans’ premiums have risen steadily as those plans have to pay providers enough to make up for the government cost shortfalls created by Medicare & Medicaid. These cost shortfalls (to hospitals especially) are one of the government’s best kept dirty little secrets, and the public does not understand that Medicare and Medicaid are paying less than cost to Iowa hospitals, and that even then neither program is financially sustainable. A new public plan managed in the same manner as Medicare and Medicaid will reduce if not completely eliminate private insurance options in our market place, leaving Keokuk Area Hospital no place to make up Medicare and Medicaid cost shortfalls let alone provide any funds to care for the indigent. The government mandated plan in Massachussetts serves as a shining example of another plan crafted to provide everyone access, but which has made the cost problem even greater than it was already.
Supposition #6: The healthcare industry has so much fraud, waste, and abuse that eliminating it will also provide significant funds to assist with reform.
Reality: All industries have fraud, waste, and abuse. Fraud, waste, and abuse should be targeted and eliminated as much as possible in every industry, but should not be counted on to fund reform. In fact, the greatest amounts of fraud, waste, and abuse have been identified with Medicare and Medicaid programs which are already government health plans. What evidence is there that another government run public health plan be any different? Fraud is easily identified and should be punished whenever found. Reformers should be required to specifically identify what they call waste and abuse. (ie is a person of such and such an age getting a new knee or hip waste or abuse?)
The truth is, the healthcare industry does not need to be ashamed of the multitude of quality services that are being made available to the American public. The issue is that there are so many of these services available and so many people who would like to avail themselves of these services, that healthcare is very expensive if everyone is going to receive everything. Yes, as with any industry we can improve and be more efficient, but it is unlikely the government will be a part of improvement or efficiency. The debate about reform needs to begin again in an honest attempt to address cost drivers and how to deal with them rather than simply promising to provide access to all care for everyone and relying on wishful thinking funding mechanisms that will in all likelihood make funding of healthcare even more difficult over time. Healthcare providers should be a part of that debate.
Wally, Winkler, MBA, FACHE
Chief Financial Officer
Keokuk Health Systems, Inc.
319 526 8661
blogww@gmail.com
Thanks for your comments, Wally. That’s a very well thought out response to this post.
Hopefully when Congress returns they will get back to the facts, and return to the important discussions that were taking place before the recess.
You’ve covered a lot of the main myths, and explained the realities well. In the end this debate is really going to come down to cost and quality. The big questions will be how much will it cost/save (and how) and how much better will the system/citizens be as a result (and how). These answers are not answered easily or quickly, but the more educated the populace becomes on the issues, the sooner progress will be made.
Thanks again for your post. Glad you found the IHA Policy Blog!