THE VIRGINIAN-PILOT
Copyright (c) 1997, Landmark Communications, Inc.
DATE: Wednesday, January 8, 1997 TAG: 9701080005
SECTION: FRONT PAGE: A11 EDITION: FINAL
TYPE: Opinion
SOURCE: GLENN ALLEN SCOTT
LENGTH: 79 lines
Sooner or later, fee-for-service medicine was going to be done in by uncontrolled cost increases for health care.
Call me a slow learner, but it dawned on me only a decade ago that fee-for-service was headed for big trouble.
Health-care-cost increases annually outpaced increases in the overall Consumer Price Index.
And the health-insurance premium at The Virginian-Pilot consumed an ever-increasing chunk of my pay.
Clearly, any unhappiness I had about the rising cost of health care was of no consequence. But also, clearly, the unhappiness of America's corporations, state and local governments and federal government would bring change.
Revolutionary change, as it turned out. Fee-for-service medicine is still around, but millions of consumers of health care have been pushed into managed-care plans, and the pushing continues. The health-care world is in a turmoil from the revolt against skyrocketing costs.
In most respects, that's a good thing. Third-party payment of health-care bills - payment by health-insurance companies and government - had long given health-care providers something close to a blank check. Third-party payment assured physicians and hospitals that a respectable portion of any bill run up by patients would be paid. The more health-care services delivered, the bigger the bills and the bigger the payments.
Couldn't last forever. Now that government and the private sector have prodded or commanded millions into entrusting their physical and mental well-being to managed care, we have learned just how much fat our health-care dollars supported.
The United States had acquired about twice as many hospital rooms as were needed; in short supply at the end of World War II, hospitals were overbuilt with the encouragement of Hill-Burton Act funds from Washington. On average, patients stayed in hospitals far longer than necessary. Psychiatric hospitals proliferated, underwritten by health insurers' policy of paying a larger portion of the bills for inpatients' care than for outpatients.'
Specialists proliferated far beyond actual, as opposed to artificially inflated, demand for their expertise, while less highly compensated general practitioners became a shrinking percentage of the physician population.
American high-end medicine was - and still is - the best anywhere. But the jury-rigged American health-care system shuts out millions while also being extremely wasteful.
U.S. health-care spending shot up from $250 million a year in 1980 to $1 trillion in 1995 - 14 percent of gross domestic product. Nonprofit and for-profit insurance companies and the government lamented runaway medical costs and spoke repeatedly of their efforts to rein them in.
But hospitals were getting richer, hospital executives were getting richer, physicians were getting richer, health-insurance companies were getting richer. The system was biased against real cost containment. The more money flowing through the system, the more money insurers pocketed, so how serious could they have been about taming costs?
Then the crash. Corporations shifted to managed-care programs, as did governments. Costs are now coming under control. Many hospitals have closed. Thousands of health-care workers, some of them physicians, have lost their jobs.
Financial rewards for managed-care providers are tied to controlling costs. Now some health-maintenance organizations are profiting enormously, as are their executives. Unfortunately, managed care can be hazardous to the health of some patients.
A University of Virginia group, chaired by ethicist John Fletcher, studied the ethical issues posed by managed care. The group reported that while fee-for-service medicine invited overtreatment for financial gain, managed care leads to undertreatment of the sick to boost corporations' income.
The U.Va. study was cited by James E. Thompson, M.D., 108th president of the Southern Surgical Association, in an address to his colleagues in Hot Springs, Va., 13 months ago. Thompson saw no easy answers to the ethical challenges posed by managed care, but he offered this counsel to his fellow physicians:
``(I)t is vital that we do what we know how to do, and that is, take care of patients. . . . We went into medicine to help sick people, and there still are plenty of them around. . . . many of (them) poor.'' MEMO: Mr. Scott is associate editor of the editorial page of The
Virginian-Pilot.