November’s elections undoubtedly changed the dynamic of this nation’s governance. Domestically, no element more closely affects individual Americans than health care.
As we enter the new year in Washington, we have Democrats now in control of both houses of Congress, albeit with a Republican still wielding a veto pen in the White House.
In Boston, Democrats retain firm control of the Legislature. But now they have an ally in the corner office and no longer do their decisions have to be passed by a veto-proof margin.
What does this mean?
The Advisory Board of To Your Good Health, A Health Care Newsletter, discussed this subject in depth during its most recent meeting at the Four Points By Sheraton Hyannis Resort.
Big things may be expected in both venues, although there were, of course, the usual caveats from key aides to our top legislators.
“How it shakes out, we’ll have to wait and see,” warned Neva Flaherty, Congressman Bill Delahunt’s Hyannis health care specialist. “Keep in mind, anything that involves spending more money comes up against the Democrats’ pay-as-you-go promise. But, on the other hand, a lot of social issues have been neglected fiscally under the Bush Administration and this is a situation the Democrats want to correct.”
Ms. Flaherty pointed out that a stem cell research bill passed by both houses last year only to be vetoed by President George W. Bush assuredly will come up again. “The head count says they still probably don’t have enough votes to over-ride (another veto),” she said, “But I think they’re hoping that the President is now in a weaker position politically and so may be inclined to let it go by.”
Sue Rohrbach, Cape aide to State Senator Rob O’Leary, also was unable to predict definitively what course new Governor Deval Patrick might steer. One reason, she explained, involves the sheer complexity of the state’s new comprehensive health insurance plan. Passed last April, it still has kinks to straighten. “So much still needs to be done (on the bill), it’s probably going to take up a majority of the new governor’s agenda,” she said. “As we find out where the bugs are, it may have to be revisited legislatively. Funding is also an issue.”
Normally, we sum up opinions from our blue ribbon Advisory Board into a single comprehensive story. But this subject has too many elements.
So we’ll just break them down, with room here and there for commentary…and maybe a little wishful thinking.
Larry Fox
Congressional Agenda
In general, it’s “Preserving Medicare and Social Security and changing the initiative toward privatization of government services.”
Some specifics on issues that affect the public directly:
O’Leary’s Plan
While most of the state’s legislative agenda on health care probably will focus on the new coverage-for-all bill passed last spring, Senator Rob O’Leary (D-Cummaquid) has concentrated on crafting a new law to achieve Medical Malpractice Reform. This had been included in last year’s bill, only to disappear during conference committee deliberations.
Senator O’Leary is proposing a three-tiered initiative:
If Wishing Could Make It So…
Here are some of the issues other Advisory Board members would like to see addressed:
Steve Abbott, President/CEO of Cape Cod Healthcare: Nixing some negatives such as “mandated nurse and staffing ratios, an issue that doesn’t seem to die; and the impact on community hospitals of so-called niche players like surgery and imaging centers who don’t have to cross-subsidize those other services that don’t really pay so well and often are the ones most needed.”
Gary Sheehan, President/CEO of Cape Medical Supply: Questions how to deal with the newly instituted 36-month cap for reimbursement for home oxygen use. “Our service obligations don’t magically end at a given period of time and we’re concerned about situations that could result in re-hospitalization. Talk of (further) cutting the cap to 13 months doesn’t make things easier for patients as well as an industry that already has been hit by decreasing reimbursement rates.”
Dr. Arthur Bickford: “I’d like to see more people testifying in favor of a single-payer system. I practiced in England for a while and I found it delightful.”
Andy Young, former trustee Cape Cod Hospital: “I’m afraid the single-payer system may be a ‘third rail,’ like fooling with Social Security.”
Dr. Herbert O. Mathewson: “I’d like to see implementation of improvements and quality control like at VA hospitals continue and reinstatement of the budgets for Ryan White AIDS services. Cape Cod Hospital’s Infectious Disease Services was one of the original Ryan White grantees and the program has really grown, with the staff increasing from one to 16 in recent years.”
…And Who’ll Treat The Sick?
If all the programs are enacted and funded so all the sick could be healed, who will provide the treatment? Shortages of both nurses and physicians here and elsewhere are getting worse.
Sue Miller, Associate Dean at Cape Cod Community College in charge of the health care programs: “I still see finding people to care for the sick as a critical issue. There’s a shortage of good nurses…and teachers as well. And if you don’t have the faculty to run your programs, you’re not going to have nurses. I’d like to see the federal government look at funding both nurses and teachers. Medicare once did fund medical and nursing education. But now nurses and nurse practitioners can’t afford to take the pay cut to go back into teaching. It’s a crisis that’s not going to go away for a long time.”
[Steve Abbott comments: “That’s a basic thing of the marke- place. If you can make more doing than teaching, well, you’re going to be doing.”]
Steve Abbott, President/CEO of Cape Cod Healthcare: “Our buildings have received a lot of attention this past fall, but right now our focus is on attracting primary care physicians. Last year we brought in eight and lost 12. Years ago, primary care was a popular field, now doctors want to do anything but primary care. It’s a shrinking pool and the only primary care docs we’ve brought to the Cape recently are ones we’ve hired. This is a first-class national dilemma that can best be addressed on the federal level.”