| By Chelsea Hadaway Charleston-area health care and civic leaders met this week to offer a local and multifaceted perspective on health care reform. The discussion held at the Trident United Way offices on Rivers Avenue in North Charleston was part of many community meetings being held across the country at the request of the President-elect Barack Obama’s transition team to help shape policy and the next set of moves in health care. Bill Settlemyer, founder of the Charleston Regional Business Journal, was invited to lead the session, which brought together civic leaders, hospital leaders, Statehouse representatives, advocacy groups and educators. Although a collective desire for health care reform shaped the foundation for the discussion Tuesday, the insights and expertise of the various leaders led to many views on what the solutions are. Many leaders agreed the system is too fragmented, too profit-driven and too inefficient. Almost all of the 30 leaders at the meeting think a complete overhaul of the system, including some sort of universal health care, is necessary.
“We need to have a wellness model instead of a sickness model,” said Patricia Johnson, CEO of Summerville Medical Center. Casey Fitts, a physician and founder of Tri-County Project Care, agreed the system is working from the sick end now and said people don’t know how to access health care. Too fragmented Many agreed that the fragmentation of the system leads to inefficiency and overspending of resources, as well as duplication of services. “We have parts of a system. We need an engineer to pull it all together,” said Frank Knapp, president of the S.C. Small Business Chamber of Commerce. But more cooperation between state and federal agencies would mean the need to give up some autonomy, said Susan Berkowitz, director for the S.C. Appleseed Legal Justice Center. “There’s a clear breakdown at the macro level,” Berkowitz said. Groups must share information and give up some of their feelings of ownership, she said. Too expensive From the provider standpoint, the cost of medical education and malpractice risks arose as concerns and part of the problem. John Simkovich, director of public health for Department of Health and Environmental Control Region 7, pointed out that the cost of going to medical and dental school has shot up in past years and said the government should subsidize or decrease cost of education for health care providers. Ray Greenberg, president of the Medical University of South Carolina, agreed, saying that doctors come out of medical school with an average debt of $150,000 to $200,000. This leads many graduates to choose more lucrative fields versus primary care or working in medically underserved areas. “It’s a perverse financial incentive,” Greenberg said. The pay is higher for areas in lesser demand, and fields such as primary care are suffering because they don’t pay as well. In another financially tied issue, Johnson said a call for tort reform is necessary. As doctors become more concerned with litigation, they over-order tests, for example, driving up the cost of health care. As the cost of care escalates and becomes out of reach for some, people’s access to and use of proper health care diminishes. “For me, the biggest problem with health care is cost,” said state Rep. Anton Gunn, D-Columbia. “We have a system that is interested in making a profit, not improving people’s health.” The solution The consensus was that different solutions are needed, with different levels of governmental control. Several people agreed this couldn’t be left up to the federal government. And some attendees issued a call for a federal systemic overhaul. Greenberg suggested that a solution for the whole system is needed instead of trying to put a Band-Aid on particular problems. “So much of what we’ve been talking about is tinkering with the margins,” he said. | Among the points made at the meeting The current health care system works from the sick end and not the well end. (Casey Fitts, physician and founder of Tri-County Project Care)
There are too many parts to the system, which leads to overspending of resources. (Patricia Johnson, CEO of Summerville Medical Center)
People in leadership positions need to pull the parts of the system together. (Frank Knapp, CEO of the S.C. Small Business Chamber of Commerce)
The system is profit-driven instead of service-driven. (S.C. Rep. Anton Gunn, D-Columbia)
A focus is needed on prevention and bringing children into better health. (Dave Spurlock, Charleston County School District)
The cost of medical and dental education is out of hand and needs to be decreased. (John Simkovich, DHEC director of public health for Region 7)
The high cost of medical education leads to “perverse financial incentives” that influence doctors to take jobs in more lucrative fields instead of primary care or medically underserved areas. (Ray Greenberg, president of the Medical University of South Carolina)
Health care providers need better education on health issues in the black community. (Thaddeus Bell, associate dean at MUSC)
Tort reform is needed to decrease the incidence of litigation against doctors. (Johnson)
State agencies and organizations need to share information. (Susan Berkowitz, director of the S.C. Appleseed Legal Justice Center)
Information sharing needs to be done at the federal level in order to fix the whole system and not just put a Band-Aid on particular problems. (Greenberg) |
Health care leaders converge, diverge on solutions for reform of system
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Comments:
Added: 2 Jan 2009
For us in the Construction field. We really pay for it twice by Providing Health insurance and Workers Comp. This drives up the cost of all our Services.
Matt O'Donnell
Added: 2 Jan 2009
Who is going to pay for this sort of (FREE )universal health care? I have paided for my family through working jobs all my life. Now a bunch of do gooders want to raise my taxes when I am retired and on a fixed income for people who don't want to work but thinks everyone owes them something. Go to work or do with out. We have social health ins. ,its called medicaid. If you don't get medicaid work harder and support your faimly like the rest of us did.
bargeman
Added: 2 Jan 2009
The healthcare system, as we know it, will cease to exist in coming years. The forces of destruction, innovation and recreation have been mobilized and cannot be turned back. Our opportunity during this time of uncertainty is to redesign healthcare completely from the inside-out. The first priority should be to provide quality and access to all Americans. As a nation, we can choose to pay for citizens to be healthy or we can pay for citizens to be sick. This is not a matter of free enterprise vs. socialized medicine; it is a matter of our international competitiveness. Healthy citizens contribute to wealth creation and enhance social capital. Currently corporations, saddled with an ever increasing healthcare burden, experience a significant competitive disadvantage; and aspiring entrepreneurs, when faced with the healthcare issue, become reluctant to start new firms. Our economic future depends on our ability to deal with this problem. The primary obstacles to reform will be entrenched institutions that profit from inefficiency, lack of competition, and those individuals satisfied with paying a premium for substandard care. In reality, the current system is unsustainable…the question is: “who will give up a piece of their empire to make it better�
Russell Cook
Added: 2 Jan 2009
We published an opinion piece recently in the Business Journal on this topic that generated a lot of interest. I will cross post over on that story, but you can read it here: http://tinyurl.com/724ql4
Andy
Added: 3 Jan 2009
As the president of two primary care med-mal insurance companies for physicians, I assure you that primary care doctors are deeply concerned every day of their lives about being sued - and frustrated about their patients' general ill-health. Doctors are hampered in their desire to provide time for quality health-care, lifestyle, and dietary guidance. Consider: 35% of all Americans are obese, 74% are simply fat; 20% are drug or alcohol abusers; 26% use tobacco. 25% of all American female teenagers have some kind of STD. Frankly, we are woefully ill before we ever see a doctor. Which primary care pediatrician or obstetrician has time enough to counsel patients well on diet, exercise, drug use, tobacco and fatness? They can neither test for nor follow-up on most of them. How can they fight 4.5 daily hours of an average citizen's TV watching of fast food and sugar-based cola commercials, or encourage more than the average 16 minutes of exercise obtained from walking to the office water cooler? When patients get sick, and then sicker, it is blamed on the doctor. The mere threat of a lawsuit and its cost drives a settlement, unfair or frivolous as it may be. And the complexity of medicine is now totally inexplicable to a jury of intelligent citizens - though many of them will not have H.S. diplomas. Bad outcomes arise because - generally - patients are in poor health, not because doctors err. Education. Time. Training. Jefferson was surely right: if we do not provide for a well-educated electorate, democratic institutions will crumble. Look around you (or read the front page of the Wall Street Journal) and you'll see the decline and fall of our dear, benighted country. It's a tragedy - a tragedy driven by ignorance and greed.
Eugene Rosov
Added: 4 Jan 2009
Eugene, great post. I hope some doctors and lawyers chime in as well. I know for some of the employers we talk to (mostly small) the cost of health care is a competitive issue in terms of recruiting and retaining workers and in competing with larger and foreign companies who have lower or no costs. One thing stuck out though in your post: "25% of all American female teenagers have some kind of STD." That's alarming. I wonder what the stats are for male teens. Thanks,
Andy
Added: 4 Jan 2009
At the macro level, we in the US of A spend near $210 billion/year for health, which per capita is equivalent to about $6,800. Of this we spend almost $2,000 for administrative cost more than any other developed countries which cover each of their citizen with universal health care (UHC). Those countries and the USA get similar health status results for their population. Therefore, Who will pay for our UHC? is not the question (there is enough money allocated to health care) but how is the money presently spent to be realocated to save on system management and cover more people.More $ can be transfered from high-tech medicine to much cheaper preventive health.This aspect is becomes more important as lifestyle will play a growing role with an aging population. At the Micro level, individual should be able to access any point of service with a Health ID card containing most if not all relevant information. This card with a memory microchip would be updated as needed (determined by the care provided and patient) and the information would also be stored in a local Health Management Information System (HMIS) to be used as part of a data base for Health service improvement. The care provider would have to spend a determined minimum amount of time for prevention with each patient. (Many do it already) The present multiple system of health networks is wasteful, non accessible to too many and expensive for those who get coverage. One single National Health System should cover each legal US citizen while some insurance would provide elective or luxury care services.
de Malvinsky Jean
