Panel agrees on need for universal health care, though approaches differ

BEREA, Ohio — Is America ready for health care reform?

Are caregivers, patients and insurers willing to make the sacrifices to support quality health care for all?

Maybe not yet.

A panel of health care professionals and analysts who discussed health care reform at Baldwin-Wallace College on Monday evening could agree on one point, though: America needs a universal health care system.

But their discussion showed the reluctance of most people to give up something to arrive at that goal.

Caregivers would have to accept less payment for sick care and do more to help patients stay well.

Patients would have to take responsibility for living healthy lifestyles and paying for some if their care.

Private insurers would have to accept lower profits and executive compensation. All insurers, including the federal Medicare and Medicaid programs, would have find ways to get everyone in the system to minimize costs and maximize benefits.

Not even part of Monday’s discussion, drug and device makers would have to accept reasonable payment for their products and develop products that save money.

Here are some excerpts from the evening’s discussion:

Dr. Javier Lopez, a native of Columbia, was a general practitioner and surgeon in Greater Cleveland for 45 years. Dr. Lopez retired several months ago from private practice and went to work as a health policy analyst for U.S. Rep. Dennis Kucinich.

“I loved every minute of my practice. I enjoyed the interaction with my patients. My only disappointment upon retiring is to see there are so many people without insurance in this great country.

“For many decades, they have promised us health care for every American. But the uninsured continues to grow at a staggering rate, reaching I feel now at least $50 million without insurance, with all the layoffs and closures of companies.

“The private sector with all the HMOs and managed care have done absolutely nothing to help this problem. The premiums and the co-pays continue to rise very rapidly…

“There is no question in my mind, and I have been in many countries in the world, that we have the best medical care that can be provided in the world. However, this country is spending… more than any country in the world… and in measures of performance, it under-performs many other countries.”

Dr. Barry Malinowski, pediatrician and teacher at Cincinnati Children’s Hospital; medical director for Anthem Blue Cross and Blue Shield in Ohio.

“The biggest thing we need to tackle in regards to health care reform is quality. The other thing I think is important and sometimes gets overlooked is the personal responsibility that I think all of as Americans have to take better care of ourselves.

“Speaking on quality, one of the first things we need to do as physicians in hospitals is practice and use evidence-based medicine. That’s something that we need to put more money to, both the government and insurers like Anthem.

“I’ve read statistics where it says that up to 30 percent of our health care spend is on redundant, inappropriate care.

“Another area with regards to quality, medical errors, adverse events related to drugs. On an annual basis, over 30,000 people die due to medical errors, 2.5 million extra hospital days are the result of medical errors. From a cost standpoint, over $9 billion a year is the result of medical errors and adverse drug events.”

Use of electronic health records, electronic prescriptions and better electronic connectivity among health care providers might help with the medical error problem, Malinowski said. He’d also like to see reform of the medical malpractice system, as well as a crackdown on insurance fraud. Generic medicines might be a low-cost alternative to pricey brand-name drugs, he said.

Bill Ryan, president and chief executive, Center for Health Policy Affairs, an association for Northeast Ohio hospitals; former Ohio Medicaid director.

“I would say we in this country don’t have a health-care system, we have a sick-care system. If you’re sick, we can fix you. We don’t do very much in this country to keep you well.

“If you’re poor and you need to see a doctor because you have a cold, good luck. If you’re poor and show up in an emergency room having a heart attack and you need a bypass, you’ll get your bypass.

“We built a system… that will pay for the most expensive care in the most expensive settings, but won’t pay for basic preventive and primary care.

“We’re not going to make any progress in health care reform until we decide what people are entitled to…. We have to decide what we’re going to pay for and build a system to meet those needs.

“What has caused health care costs to go four times the [overall rate of inflation] is both consumption and new types of technology, new types of procedures… We refuse to make choices. We just assume that everybody should get everything.

“Coverage is not the issue. There are hundreds of thousands of people in this community who have coverage but can’t afford health care. Their deductibles are too high. Their copays are too high.

“Access is the issue. And the only way we can parse through access is if we have an honest conversation about what … in health care is a right… and what in health care is an economic good.”

Thomas Campanella, director of the health care MBA program at Baldwin-Wallace; former vice president of health care finance and care management at Medical Mutual of Ohio.

“One of the biggest challenges in health care is we don’t have a plan… Issues of health care cost, quality and access are there in any country. We’ve got to determine what makes sense for us, and then determine… how do we get there?

“One of the key things that we need to recognize is we have scarce resources….  We’ve got to in a very rational, pragmatic way, determine what we want to cover, who’s going to be covered, and who’s going to pay for it.

“One of the first things we can do is focus on developing a comprehensive primary-care network. We need to focus on primary care, keeping people well, and tying that to the payment system.

“How do we pay for service? We talk about wanting to find ways to keep people well.  But guess what? Medicare, Medicaid and managed care do not pay providers to keep people well. We talk about chronic care being a major problem. But do we have a payment system that addresses chronic care management and reimburses accordingly?

“We talk about over-utilization, but we have a payment system… that rewards for more utilization.”

Photo illustration from www.edflix.org.