Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, May 9, 1993 TAG: 9305090271
SECTION: HORIZON PAGE: F1 EDITION: METRO
SOURCE: Carolyn Click
DATELINE: LENGTH: Long
They cling to the Norman Rockwell version of things, of the kindly country doctor who makes house calls and heals as much with his bedside manner as with the limited tools in his black bag.
Even when they demand that doctors and hospitals pull out all the stops - order up the MRIs and the EKGs and other alphabet soup of the high-tech age - there is a disconnect between the consumption and the cost.
But advocates of managed competition say Americans must make that connection - must understand how health care eats up 14 percent of the annual gross domestic product - in order to rein in costs and assure that all people have access to reasonably priced, quality medical treatments.
Just as no one would purchase a car without asking the price, there are suggestions that patients are unwise if they do not explore the cost of obtaining everything from an appendectomy to open-heart surgery.
But the very nature of disease, its peculiar vagaries and permutations, adds complications to the simple checkbook transaction that takes place when we buy a car or purchase a soft drink.
For sure, the days of unfettered medical treatment are on the wane.
Insurers routinely require physicians and hospitals to justify treatments, medical tests and length of hospital stay. Many employers provide a menu of health-care benefits an employee may choose from.
But in the brave new era of managed competition, do citizens have to reduce their pursuit of health-care happiness to analogies about cars and cafeterias?
Roberta Culbertson doesn't think so. Culbertson, associate director of the Virginia Foundation for the Humanities at the University of Virginia, is coordinating a yearlong project called The Public Voice. It is designed to give citizens a forum for analyzing changes that are taking place in American health care.
Funded with $7,500 from the Kettering Foundation's National Issues Forum and aided by UVa's Virginia Health Policy Research Center, the project piggybacks its forums on other public meetings - for example, a local session of the American Association of Retired Persons.
The two-hour forums start with a 15-minute film that lays out the terminology of the health-care debate - explaining everything from managed competition to single-payer plans - so that participants will be able to understand the fundamentals of the health-care debate taking place in Washington and the dimension of the problem.
"People are presented with choices and walked through the pros and cons of the choices," she said. "Then people begin to think what they really value and what they would be willing to give up."
In the 30 or so sessions that have taken place so far, there has been considerable talk of losing touch with the traditional family doctor so fondly immortalized in that Rockwell drawing.
There also is interest in national health insurance, known as a single-payer plan, that would essentially build on the Medicare plan already in place for older Americans. In tandem with that is skepticism about the government's ability to manage such a gargantuan undertaking.
She has heard the frustration over the system's focus on illness rather than wellness, and the lack of financial incentives to maintaining healthy lifestyles.
"I hear people say, `I don't think I should be responsible for someone who drinks or smokes,' " she said.
So far, doctors and hospitals have fared fairly well in the public debates, although highly paid specialists come in for criticism. Insurers and pharmaceutical companies bear the brunt of scorn.
"Unless they have a bad experience, they are glad the hospital is there; but the insurance company, they can't figure them out," said Culbertson.
At the end of the sessions, participants are asked to fill out questionnaires. Results will be analyzed by the Virginia Health Policy Research Center and forwarded to both the Clinton health-care commission and the Joint Commission on Health Care for All Virginians, which is working to develop better delivery of health care to the state's residents.
Karma Castleberry, a clinical nurse specialist who teaches at Radford University, has served as a volunteer leader for a half-dozen of the forums.
"I sense a great deal of social responsibility on the part of the participants, from the viewpoint that we are our brother's keepers," said Castleberry. "I think there is much less isolationism than even I examined."
And while there is nearly uniform endorsement of the concept of universal access to basic health care, she said forum participants also realize that fulfilling that pledge involves compromise over just what basic health care entails.
Almost everyone who attends the forum has had some experience that has shaped his or her attitude about the delivery of health care. Everyone is searching for more information about medical institutions, how prices are reached and what the level of care really is.
"There is ample skepticism how much things really need to cost," Castleberry said.
The fact that people are now more willing to draw connections between lifestyle and disease may also dovetail with the rise of managed competition, although critics see potential pitfalls as well.
"What probably should follow this is discussions less about health-care costs and more about what the notion of health is, because this is where the forum ends up," said Culbertson.
by CNB