Covener: Doug Hendren Scribe: Liza Q. Wirtz
Earth & Tea 11:45 a.m.
Attendees:
1. Doug Hendren, Hess Orthopaedics, session convener
2. Nancy Beall
3. Liza Q. Wirtz, Blue Ridge Legal Services
4. April Hedrick, Shenandoah Eye Care
5. Joyce Major, consultant & counselor
6. Emily Sterrett
7. Trevor Chase, PolicSci JMU
8. Rachel Aeschliman, H’burg/R’ham Health Dept
9. Connie Birch, Augusta Coalition for Peace & Justice
10. Cory Partlow, Shenandoah Eye Care
11. Stan Farther, Membership Dept H’burg/R’ham COC
12. Bruce Lundeen, Shenandoah Valley Pure Water Forum
13. Ann Zimmer
14. Brooke Lohr
15. Kai Degner
Doug: orthopaedic surgeon who is also interested in alternative health and in MBA program for sustainable business in WA state.
Doug: Qs: How does health care follow any of the rules that apply to any other business? There’s no other business where you can’t control costs, what you’re paid, anything—all you know is costs go up and risks, if you’re lucky, stay static. How do we take care of people—do the stuff that made us want to be doctors—and keep this other stuff from rolling over us like a steamroller? How do we deal with these things on a nat’l level, where huge interests—pharma, for-profit health-care intermediaries on NYSE—are so dominant?
Joyce: also, consumers don’t function in health care as in, say, restaurant business.
Doug: physicians don’t learn any of this in a straightforward fashion—it’s piecemeal over time, b/c every company pays differently for different things and it’s breaking a federal law to ask the surgeon across the street what they charge for a hip replacement. No rules. The Wild West. Every company can charge what it pleases, and you have to try to keep your shirt while you figure out what to do to keep your doors open. Philosophical issues: I don’t feel good charging this much for this svc, but if we don’t we’re going to go out of business b/c we’re having to provide all these svcs for free. Ultimate conclusion: have to act like a business or we can’t serve anyone.
Stan: competition’s a given, b/c this is America & that’s how the market works. Suggestion: take it as such and concentrate on exchange of information, so that medical professionals and clients have more information about svcs, products, etc. readily available to them.
Liza: socioeconomically disadvantaged people don’t necessarily have choice, don’t necessarily benefit from competition.
Connie: arguable that drs don’t do good job at self-policing.
–>Doug: actually, we try hard, but law is v. complicated & sometimes counterproductive, and once someone’s credentialed and hired it’s extremely hard to get rid of them no matter how hard one tries.
–>Joyce: why?
–>Doug: guess is that legal concepts protecting personal liberty are stronger than legal concepts protecting consumers.
–>Emily: perhaps it’s that ABA has powerful lobby?
–>Doug: factually, they aren’t as powerful as they used to be—stats suggest that more doctors don’t belong than do. Smaller specialty groups are more active.
Doug: one year ago more or less today, the Wall Street Journal took Carilion to task b/c it had essentially monopolized the health-care industry in Roanoke and driven up health-care costs from lowest in state to highest in state. [http://online.wsj.com/article/SB121986172394776997.html?mod=hpp_us_pageone requires subscription; http://webreprints.djreprints.com/2017630549095.pdf is full article in PDF format from organization called Citizens Coalition for Responsible Health Care that reprinted it as part of an ad campaign right after it was published.] Good example of consolidation into a monopoly. Department of Justice tried to prevent, so there was national involvement in problem. But it failed, and once that monopoly’s established, nothing to prevent network from raising prices to highest in state. Doug has some concern that this is beginning to happen all over the country. Over the last 18 months, the great majority of specialists in this area have failed in private practice in the blink of an eye & gone to get supported under hospital umbrella, where they can maintain their income and be protected from undue expenses. So we’re establishing a local monopoly by a different mechanism. Another thing that’s coming up: go see a given hospital-based practice these days and you don’t necessary know who you’re going to see, as opposed to private practices, where you expect to see and do see a consistent care provider.
Doug: personal view: badly need single-payer system of some kind. Definition of kind is key.
Connie: are we headed towards a time when there will be no health care for socioeconomically disadvantaged people, esp. in rural areas?
–>Doug: profoundly hope not.
Nancy: do hospitals think that they can give better care as a monopoly?
–>Doug: certainly they wd say so. Tim Jost will probably be talking to this @ 1:30 pm. V. knowledgeable; familiar w/ European models.
Doug: Best aspect of competition is that it lowers costs & improves quality. Theoretically, therefore, you want to take your resources & use them well—and if they’re being underused, that’s economically disadvantageous. Alternatively, establish monopoly pricing, the way Carilion did. Can anyone suggest sane controls to achieve the former w/o get the latter?
–>Joyce: we’re fooling ourselves if we think we’ve really got a competitive system. What we need before socialized medicine is transparency and consumer rights.
–>Doug: almost anywhere else in the country, it’s possible for almost anyone to build, practice in, and fully utilize a facility/developed collection of medical machinery/etc. Urologist, pain specialist—all providers in area can participate/use. In VA, if you want to do this, Certificate of Public Need has to be granted @ the state level. It’s v. expensive—$20K just to send for application; going through process costs quarter of a million, requires hiring lobbyist, etc. Without a COPN, practice can assist only private paying & insured customers—no federally insured, no docs who don’t work in the same office. Not politically or financially transparent; it’s all about money. E.g., at Hess Orthopaedic, can have X-ray, b/c necessary for specific work they do; can’t have MRI; have operating room, but only for Hess’s own doctors—can’t use it as source of revenue by allowing other practitioners not part of the practice to rent it. Resource imbalance endangers their existence.
Doug: single-payer debate is being hopelessly muddled by all sorts of people @ the nat’l level. We don’t even know how to frame the questions.
–>Emily: if Town Hall mtgs were more like today’s Summit—i.e., not built on adversarial model—that debate might be going more smoothly.
Kai: likes idea of competitive public option that can compete w/ private options—seems like good compromise, whereas single-payer system, not so comfortable. Relative in Germany, e.g., is covered by public option but also has the choice of going private.
–>Nancy: thinks removal of private option is what people are most afraid of.
–>Kai: public option on offer right now not “gold standard”—and maybe not what people want—but it might be what they need.
–>Nancy: like the choice available b/t public & private school.
Doug: Medicare recipients don’t get a different quality of care b/c they’re on Medicare, but payment is handled differently, made in different amts, much simpler process.
Kai: This proposed legislation requires people to have insurance in some way—requires businesses to provide it one way or another. What could a competitive health-care industry want more than for all possible consumers to be forced into needing those services? Guaranteed consumer base.
–>Cory: physicians are worried about having their reimbursements cut. If you have to see more & more patients, eventually quality of care goes down.
–>Doug: another consideration here: not just how many folks can you see, but what does it cost you to provide the care? Medicare is an example: they don’t pay medical professionals much, but it doesn’t cost much to provide that care—simple, streamlined—no offices full of people making phone calls all day to try to get a given service/procedure/etc covered.
–>Stan: sounds like care is rationed more now by private insurers than by Medicare, which is existing single-care part of our system.
–>Doug: great point.
–>Connie: (1) @ 30% of our health-care dollars right now are not spent on health care; they’re spent on office staff, on CEO salaries, on bureaucratic process. (2) Not real worried about private health-care industry. They had their chance in the 1970s. But q: why should employers have to pay for your health care? That automatically puts some employers at a disadvantage. Single-payer system, w/ govt paying for it, removes that disadvantage for the businesses.
–>Doug: Tom Pike soon to publish book called Sick Call. He told Doug that @ 31–32% of our health-care dollars right now in this country are being consumed by paperwork. In a normal paperwork-intensive industry, that percentage might get up to 15%.
–>Stan: and in some less paperwork-intensive industries, cd be 5%.
–>Doug: when he was tracking Kaiser in CA, it was well into its 2d generation & managing to give good care while keeping paperwork cost down to single digits.
Connie: Anyone elected to Congress will get health care for the rest of their life, regardless of whether they’re re-elected. Rather robs them of incentive to fix the current system.
Stan: in some states, one insurer controls up to 60–70% of market.
–>Kai: Tim has stat in his presentation saying that something like 86% of H’burg insured people are covered by Anthem.
Contact: Doug Hendren
