The New Health Care Law: A hospital perspective
The Arizona Legislature, in a vote sharply divided by party lines, has thrown out the babies with the bathwater.
Wednesday, Arizona became the first state in the nation to abandon S-Chip, the Children's Health Insurance Program, leaving 47,000 children without insurance coverage. The action is another in a series of cuts to pare Arizona's bleeding budget. Now, over 300,000 in the state have no access to health care.
At the same time, the state legislature has voted to give the Governor the authority to sue the federal government over a requirement that everyone have health insurance coverage by 2014, a mandate of the Patient Protection and Affordable Care Act, the new federal health care law. Like similar actions in other states, the suit would challenge that the U.S. government does not have the power to make individuals of states buy insurance.
There are clearly going to be battles that will challenge the new federal law.
Currently, there are 32 million without health insurance across the nation. The new health care law intends to plug that gap.
Why? "It's the economy, stupid!" reminded a sign in Clinton administration offices. The cost of health care coverage in the United States accounts for 16 percent of the Gross National Product, the highest percentage of any nation across the globe. Even countries with existing national health care plans devote less of the GNP to health care.
In the Verde Valley and elsewhere, if a person or family cannot afford insurance coverage, they often use the hospital Emergency Room as their family doctor. In 1986, Congress enacted the Emergency Medical Treatment & Labor Act or EMTALA, to ensure public access to emergency services by Medicare-participating hospitals, regardless of ability to pay. If they cannot pay, the hospital needs to make up the costs in other ways. The difference between costs and reimbursements has been declining during the past six years.
The administration of the Verde Valley Medical Center is unsure how the Patient Protection and Affordable Care Act will change health care operations in the long run. The new health care law is massive and complicated. It tries to assure that everyone is covered and that there is also a way to pay for that coverage.
While one side of the debate has much hope for the plan, the other side has plenty of criticism.
In the crosshairs is the health care industry itself.
Dr. James Bleicher, President and CEO of the Verde Valley institution says, "If this is the first step in many, we could be OK. If this is the only step we make, it is really not going to change the growth curve."
He wonders if it will just be a paperwork change rather than structural health care reform.
The institution is at the end of the health coverage cycle, providing care and receiving compensation. Bleicher admits that even the hospital's employees are also asking how their own health care coverage will be impacted by the changes on the horizon.
Bleicher says the hospital itself has been working toward better efficiency since 2004. He suggests that the economic slide has given a perspective of future changes driven by the health care law.
"The economic issues in Arizona are well known and they have had a profound effect on us. There are also less people seeking care in the Verde Valley, so our volumes are down. There are certain volumes in departments that you must have."
"We have to be ready. We can't just send everybody home. You can't NOT have people in OB, in the CATH lab, the OR or ICU."
"The major change will have to come with the way we deliver care, and "health,' trying to keep people healthy and out of hospitals. Right now, we are paid to take care of them in a hospital. If we set it up so that these people did much better in the long term and didn't come to the hospital, we are not compensated for it. That's where your growth curve in health care is coming from. They have to figure out how that health care compensation plan."
The hospital president believes that there will have to be a change in attitude about health care in the future if the system is to work.
"Right now, they pay us to take care of sick people. They don't pay us to not let people get sick in the first place. It's a big shift, We have never done that here in the United States. There have been examples of this with HMOs in the past, but they were never prominent in Arizona. That's going to have to come, but I don't know if it will be five, or 10 years."
He says, there are significant differences between American health care and health care provided in overseas national programs.
"We spend a lot of money on premature babies, 23 to 24 weeks and also on end of life care. That is where almost 90 percent of Medicare dollars go; if you are an elderly person ... during the last year of life, that don't necessarily help."
"Some of it is consumerism, advertising to consumers for the most expensive drugs or modalities."
"You might go to a physician for back pain and the doctor gives you and anti-inflammatory and says, "go to physical therapy and you will feel better.' But, you say, "no I want an MRI,' and go to another doctor that orders that."
Bleicher says, the bottom line for the Verde Valley hospital is that it continues to provide quality of care, despite the economics of the health care horizon.