THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Friday, February 24, 1995 TAG: 9502220134
SECTION: PORTSMOUTH CURRENTS PAGE: 08 EDITION: FINAL
TYPE: Cover Story
SOURCE: IDA KAY JORDAN, STAFF WRITER
LENGTH: Long : 146 lines
A PORTSMOUTH PHYSICIAN who believes medicine should be separated from business has written a book aimed at the average patient - the person the author says can make a difference to halt spiraling health care costs.
Although ``The Health Care Mess'' was published under a pseudonym, Dr. Robert Bear Smith, Dr. Robert K. Su, admits to being the author of the bold book that pulls no punches.
Su, an anesthesiologist on the staff of Portsmouth General Hospital, is on a crusade.
``The health care system operates for business,'' Su said in a recent interview. ``The patients and the doctors are at the bottom of the heap.''
Meaningful reform, he said, is possible only if doctors and their patients work together for change.
``A lot of doctors say it's hopeless,'' Su said. ``But I think that is wrong. I think we can change it.''
The perspective on medicine, he said, has been altered over the past 20 years by the business people who took control of health care.
He points a finger at hospitals and insurance companies.
``It's skewed the relationship between doctors and their patients,'' Su said. ``Neither the doctor nor the patient feels the patient is paying for the treatment; therefore, the doctor may not work to please you.''
Since he came to the United States 21 years ago Su has believed that the health system was in need of an overhaul.
For two decades he's watched the system deteriorate to a crisis situation, he said, but he never expected it to come so quickly.
Born in Taiwan, where he received an undergraduate degree in pharmacy, he went to medical school in Japan.
Su's first stop in the United States was Philadelphia, where he interned at Episcopal Hospital. He then moved to Richmond for a residency at the Medical College of Virginia.
The Su family came to Portsmouth ``really by accident.''
`There were only three anesthesiologists in Portsmouth at the time and those who were here wanted to attract others,'' he said. ``They spoke with me and I came here because my children liked being near the water.''
The Su family lives on the Western Branch of the Elizabeth River in Churchland. He and his wife, Martha, have three adult children: Henry, 29, a Richmond lawyer; Cynthia, 26 a resident in internal medicine and rehabilitation in a Philadelphia hospital; and Linda, 24, who works in her father's office on Churchland Boulevard near the city line.
But he is adamant that health care here and across the United States could be better.
Health businesses, he said, don't care about the patient or the physician.
``They are interested only in profits,'' Su said.
Both hospitals and insurance companies are overloaded with too many high-paid executives, Su said.
``We not only pay for the company executives' compensation (often excessive) but we also pay for other wasteful expenses,'' he wrote.
Su would change the insurance and hospital businesses by changing federal laws.
He would have the federal government eliminate the ``not-for-profit'' status under which many hospital operate while seeking profit.
``They are greedy,'' Su wrote. ``They inflate charges and expect a large percentage of the bills to be paid.''
He noted that the notion of ``cost shifting,'' charging some people more to pay for others, is a questionable excuse for inflated bills.
``Only 17 percent of the patients are not insured,'' Su said. ``So you have to ask where does the money go in cost shifting.''
In addition to having too many overpaid administrators, Su said, hospitals do not need to spend large sums of money to market and compete with each other.
Insurance companies have been increasing premiums for both physicians and patients for 20 years, he said.
``They know the insured are afraid of losing coverage and dare not refuse the increases,'' Su wrote. He would cap the liability costs for doctors.
Su produced figures to show that the number of health care administrators has been increasing five times faster than the number of doctors in the United States. Some people have projected that administrative costs in hospitals and insurances companies would account for half the cost of health care by the year 2020.
Physicians, Su says, have little control over what is happening in the medical field now and he anticipates that unless something changes, the doctors will be even more controlled by hospitals by the end of the century.
``Can you imagine how you will be treated if your doctors are employed by the hospital?'' he asks.
Su quarrels with the notion that patients are consumers and doctors, heath care providers.
``We should be the healers and the patients, the healed,'' he said. ``Medicine is not a commercial business. Patients are not customers''
If a person has a problem, he or she only needs a doctor, Su said.
``The patient doesn't need a broker, '' he said. ``Now there are too many people in between the patient and doctor. We must eliminate the brokers.''
Reconstruction of health care will necessitate replacing the ``not-for-profit'' profit-making hospitals with community hospitals and then taxing the existing facilities who chose to continue as they now operate.
Community hospitals, he said, would be community-controlled, non-profit facilities that would be available when the patient needed them.
``Decrease in hospital census would be welcome, instead of being worrisome news as it is to current hospital corporations and their executives,'' Su wrote.
A ``universal'' payment system, which would eliminate overbilling, would be an integral part of Su's reform plan. If everybody were paid the same for the same service, doctors would not seek to locate in more affluent areas but would go where there was a need for them.
As for insurance, Su envisions regional ``pools,'' operating under a board of local residents as a co-op and with a cap on administrative costs.
All otherwise uninsured persons in a region would be enrolled in a pool and required to pay a set fee. The government would pay Medicaid and Medicare premiums at the same rate. Citizens also would pay into escrow accounts to cover co-payments, which Su feels are necessary to remind the patient he is paying for his health care.
Persons who chose not to enroll would be required to post a bond to provide for payment of their health care.
Physicians would have to change too, Su said. They would have to ``place a patient's interest above their own interest.''
Su would have physicians sever all ties with for-profit health care companies.
Under Su's plan, a state board would examine a doctor's credentials and record and have authority to revoke a license for certain misconduct.
The public, too, would have to take responsibility for health care reform, he said.
The patients must ``use services wisely and judiciously,'' determine circumstances for terminating expensive life-support systems, avoid health-hazardous habits and behavior and stop violence, he said.
``I believe we can save one-third of the cost of health care today,'' he said. ``That's $350 billion.'' MEMO: Related story also on page 8. ILLUSTRATION: Color photo on cover
Dr. Robert K. Su displays the book, ``The Health Care Mess,'' in
a photograph by Gary C. Knapp. The book is published by Northwest
Publishing Inc. and available at local bookstores for $7.95.
Staff photo by MARK MITCHELL
Dr. Robert K. Su, an anesthesiologist at Portsmouth General
Hospital, blames hospitals and insurance companies for the health
care crisis.
Staff photo by MARK MITCHELL
Dr. Robert K. Su, who admits being the author ``The Health Care
Mess,'' reads in the library at Portsmouth General Hospital.
by CNB