FIXING OUR HEALTHCARE DELIVERY SYSTEM:
The Goal Is Clear… The Road Is Rocky

To: Our new president
From: The Advisory Board of To Your Good Health, A Health Care Newsletter
Subject: Fixing our nation’s healthcare system
Message: It ain’t gonna be easy

This issue’s quarterly meeting of the TYGH Advisory Board took place at Cape Cod Community College before the identity of our new president was determined. The subject dealt with what kind of message would board members like to send to the White House concerning this most pressing issue.

The answer was both clear and complex.

Clear: The nation needs to adopt a single payer insurance system similar to those that exist successfully in every other advanced country in the world;

Complex: Creating an environment in which this can be achieved successfully will be extremely difficult. Other issues that must first be resolved can be summed up as creating public acceptance, easing the fiscal crunch from two other more pressing conditions—the Iraq war and our current financial crisis; eliminating ballooning excess costs unrelated to actual patient care; and, finally, taking into consideration the extra future costs as millions of baby boomers enter the Medicare system. (And, yes, having enough primary care physicians to treat our current population, much less all these extra folks.)

The most ssignificant comment concerning a single payer system came from Dr. Herbert O. Mathewson, medical director of the VNA (and TYGH medical adviser). For years, members of the medical profession have generally opposed government administered universal coverage.

But now, Dr. Mathewson declared, “Physicians are ready for a single payer system. They’re sick and tired of doing battle with multiple insurance companies. (Besides) their fees, at least on Cape Cod, already are set for 90 percent of their patients (by Medicare) so why not make it consistent and cut out the 20 percent of costs that go to administration? I only hope this 20 percent is shifted towards deliverance of care and not swallowed up with something else.”

Dr. Kathleen Schatzberg, president of Cape Cod Community College: “I believe in a universal system. Profit in the system in the form of insurance companies is part of the problem. Now, a lot of people don’t trust the government to run anything, but there are countries in the world that have universal healthcare managed by the central government…and it works.”

David Rehm, president/CEO of Hospice & Palliative Care of Cape Cod: “A single payer system is the only way out of the situation we are in, although I’m skeptical whether it can be realized. There are more healthcare lobbyists in Washington than any other industry by a factor of three and the last attempt failed because it underestimated the power of some of those interests.”

Denise Dever, president/co-owner of HomeInstead: “Why can’t we learn from other countries about going to a universal healthcare system?”

Rosemary Dillon, Director of Allied Health and Gerontology at Cape Cod Community College: “Well, we’ve got the model in place with Medicare.”

And an added commentary from Van Northcross, Regional Marketing Director of Cape Cod Hospital: “Where is the outrage with the healthcare delivery system in the United States of America…when a clear majority of Americans [56 percent in a recent poll] want a single payer system of healthcare? The insurance lobby has succeeded not only in blocking single payer health care, but in keeping it out of the public discourse.”

Cost containment was a continuing issue.

Dr. Schatzberg charged that “pharmaceutical and medical device companies are probably making even more profit than we realize” She said an Oregon experiment of, in essence “rationing” health care by refusing to cover certain procedures might be worth studying.

“Probably the most immediate problem is increasing Medicare costs between now and 2017 due to the baby boomers,” Mr. Rehm said, “If we don’t address that, the whole federal budget becomes unwieldy because it’s driven by Medicare costs.”

“If we continue to insure people into a system where costs are so out of control, we haven’t done anything to solve the problem,” agreed Gary Sheehan, president of Cape Medical Supply. “The trouble is politicians see the 45 million as a voting bloc and not as a problem. I’d still like to see some more intelligent proposals out there.”

Steve Abbott, former president of Cape Cod Healthcare, cited two often-overlooked systemic problems. One is the abundance of paperwork required to keep the wheels turning. “If the federal government could get a handle on this, we could save millions of dollars,” he declared. He also noted the increasing shortage of primary care physicians. “These people are the front door of our system, their jobs create the most disruptive lifestyles and yet they are paid the least,” he pointed out. “The government should recognize this and improve their insurance reimbursement scale.”

Carole Stasiowski, Director of Community Relations, at the Rehabilitation Hospital of the Cape and Islands, suggested the problems might be solved by taking a lead from the healthcare providers where leaders in a field get together to determine just what procedures seem to work best in different situations. “We need to get the best minds together to determine these ‘best practices,’” she said, “That’s the only thing that can determine what our priorities are for healthcare…and only the government can set those priorities.”