THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Sunday, April 9, 1995 TAG: 9504070272
SECTION: CHESAPEAKE CLIPPER PAGE: 06 EDITION: FINAL
TYPE: Another View
SOURCE: BY JUAN M. MONTERO II, M.D.
LENGTH: Medium: 93 lines
Although Americans profess to have the highest quality of medical care in the world, we also have the most expensive. Almost 15 percent of our population does not have access to critical health care without the threat of personal bankruptcy because they lack health insurance. The plight of the working poor in our health system is what brought us to the much-debated health care crisis.
The poor and the truly indigent have no problem securing health care. There is no difference in the quality of medical care or even in the amenities enjoyed by Medicaid patients and those with private health insurance.
How should we restructure the health care engine to afford universal access and coverage? Having been involved, I would say that the transmission needs no re-structuring. What we need is a major tune-up to keep the engine running smoothly.
Three major systems that affect the health care industry need repair. These are our legal system, the hospital industry and the insurance industry. They should be repaired in this order to achieve maximum results.
First, major tort reforms are needed. We are litigious to the point that no one takes personal responsibility for anything. It is always someone else's fault. Litigation, or the threat of it, unquestionably increases health care cost from the practice of defensive medicine.
My proposal is to substitute litigation with arbitration, which is less costly and more equitable across the board. If the patient is not satisfied with the ruling, he or she may still sue on the condition that if they lose, they must pay the legal costs of the defendant. This is a major but simple reform without tax money involved.
It is common sense in business to pay more attention to areas where the most money is spent if one wants to be competitive and profitable. The hospital industry takes in the biggest chunk of the health care dollar - 19 cents. Was there any talk of hospital industry reform throughout the 1994 debates? The hospital industry is treated like a sacred cow.
In Virginia, 85 percent of hospitals have non-profit status, which means these hospitals pay no taxes. Their considerable profits are automatically re-invested in capital expenditures. As a result, hospital budgets soar - to the delight of the top-ranked executives whose incentives, among other things, are big budgets to justify hefty salaries.
Have you ever seen hospitals advertise for lower room rates? These hospitals maintain one level of accommodation - first class - whether one has health insurance or not. The uninsured patient is given no choice of affordability, yet the threat of garnisheed wages or a lien on one's home is always there.
Hospital administrators equate the quality of medical care heavily with the type of accommodations and the amenities that patients receive. They worry that insurance companies might adjust their payments accordingly if cheaper rooms were available.
Truthfully, it is the competence and caring of health care providers, including physicians, that determine the quality of health care. My proposal is to do away with the non-profit status of hospitals. Those that insist on keeping it should be required to be more charitable to their respective communities. This could include support of free clinics and discounted hospital charges for those patients without health insurance. This reform would increase revenue for the government.
When the constant threat of litigation and the continuing hospital industry practice of shifting costs to patients with health insurance are corrected, the cost of health care is bound to drop without radically changing the free enterprise concept. When health insurance premiums become more affordable, the insurance companies can then make their plans more flexible with such options as eliminating pre-existing condition clauses and the adoption of community ratings. Medical IRAs or medical savings accounts should be strongly encouraged to give everyone fiscal responsibility. Capitation through managed care concepts and HMOs should be discouraged because of their ``do as little as possible at the lowest possible cost'' attitude toward quality health care. Again, no tax money would be involved.
What shall we do with the uninsured, who are truly in a health care crisis? My proposal should have an instant effect and may only cost a smidgen of tax money. Physicians who join organized health care facilities, such as free clinics for the underprivileged, should be allowed tax credits for their free service.
Lawyers in Virginia have a program providing free legal service, and those who participate can tax deduct their pro bono work. Physicians have always done their share of free medical care even with the constant threat of litigation and without tax breaks.
In Virginia, 33 free clinics are now serving the working poor of our communities. These clinics are mainly supported by the efforts of the private sector.
If we can get the health care mechanics working together on these issues, we would be able to fine tune the health care engine. We need a reliable and affordable system we can count on.
KEYWORDS: HEALTH CARE HEALTH INSURANCE MEDICAL INSURANCE by CNB