On Healthcare: My Greatest Hope and Biggest Fear

Someone recently asked me what my greatest hope for the Obama Administration is, and what my greatest fear might be. My greatest hope (from where I sit) is easy – that once he is sworn in, President Obama will tackle healthcare reform and provide healthcare coverage to the 43 million-plus Americans who do not have healthcare coverage. It seems to me that it was one of his top priorities as he ran for office, and I recall that exit polling showed that the need for healthcare reform was tied for third in terms of the issues most on voter’s minds as they cast their ballots for president.

My greatest fear is that his Administration will be so consumed with our nation’s economic woes that he won’t get to healthcare reform. But the irony is that tackling healthcare reform is essential to our nation’s economic recovery. Healthcare is 15 percent of the gross domestic product nationally. Hospitals are often the largest employer in the communities in which they serve. In New Jersey, healthcare is the state’s second largest source of jobs, with hospitals alone employing close to 150,000 New Jerseyans in full-time and part-time positions. All told, New Jersey hospitals are economic engines that pump billions of dollars in salaries, income taxes and purchased goods and services into the state’s economy.

But beyond the dollars and cents, hospitals serve as the safety net for all of those who lack health insurance. State law mandates that hospitals provide care (we call it charity care) to those who don’t have health insurance and can’t afford to pay. As the unemployment figures continue to rise in our state, that hospital safety net becomes even more essential.

So… hospitals provide jobs and add billions of dollars to the state economy, all while providing a vital service to all our residents. That, to me, makes hospitals an essential component of any economic recovery.

Written by Betsy Ryan at 19:17

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I agree with your comments. Healthcare reform is absolutely essential to this economy. The concerns that I have regarding healthcare has to do with the insurance companies dictating how to practice medicine. The guidelines for reimbursement are becoming more difficult. As an example, some insurance companies will not pay for a dialysis patient's Epogen if their Hgb is >12. Maintaining a patient's Hgb between 11 and 12 is essential for dialysis patients to maintain their quality of life. We must hold or we will not get reimbursed. If we continue to administer per doctor orders, the patient will have to be billed, which creates a hardship on the patient. Once we hold, we draw weekly labs, when the Hgb drops below 12, we need to get another pre-cert in order to continue the epo therapy. Therefore, pts's hgb drops, which may mean blood transfusions, which then means increased hospitalizations. Some of their guidelines are stricter then even Medicare. Another concern is increased hospitalizations for dialysis patients with catheters or failed fistula's. I would like to see more communication between the administrative staff of the hospitals and the outpatient dialysis facilities to reduce hospitalizations. One area of concern are the failed fistula rates and the fear of sending patients to another hospital because the surgeon has better outcomes. Early intervention, having fistula's placed while patients are stage 4 for maturation, pre-education would help eliminate patients ending up in the hospital. It needs to be a team effort. Reduction in our hospital rates, benefits the hospitals, the outpatient facilities, but more then anything, the patients are healthier.
December 12, 2008 02:29
shaija george said...
I agree with you: Health Care has too significant an impact on the economy to be ignored. Only a visionary team could create the most critical changes in the health care system that are over due. A HC system that absorbs the cost of the uninsured is sinking many hospitals now. Those who are not under an employer covered plan should be mandated to subscribe into a universal plan that would have premiums based on their income.
I hope to see the hundreds of small health plans that are very limiting, and cost absorbing (overhead expenses) dismantled as large state or national plans that provide wider coverage and less fixed cost would emerge.
Having a co-pay that could be significant enough for the curative services may promote preventive care that is grossly ignored now. Cost aware consumers would demand high standard care that is not offered by many providers in turn cutting the cost. It is a shame not to cover the necessary care, but it is also unacceptable to provide substandard care. Practitioners should be part of the decision making process on what needs to get reimbursed, not the health care plans as they please.
December 16, 2008 01:42
LuAnn Weis said...
I have always said healthcare reform is necessary to help the issues facing our economy. I am optimistic that Daschle will hit the ground running with healthcare reform. Communities are invited to have Healthcare Community Discussions until Dec. 31st. Feedback will be sent to Senator Daschel's healthcare committee. This is an opportunity for all of us to provide important feedback. Maybe NJHA would coordinate one of the meetings?? http://change.gov/page/s/hcdiscussion
December 17, 2008 01:28
Joseph Morris said...
Betsy, first let me extend a thank you for starting this blog and encouraging this type of inclusion of the health care community. It brings awareness to all of the conflicting and competing policy issues.

I agree with your selection of healthcare reform as a hope and everyone’s fear is that our nation’s economic woes will block efforts on healthcare reform. First to dispel the fear – health care is too large a part of the economy that it will take a back seat for too long (my fear is that we’ll find out a lot more troubles have been hidden and our challenge is even greater – when faced with such reality all I can suggest is prayer – after all pastoral care is one of my direct reports – it does work).

As to health care reform –if it is truly be reform – then we must understand that like Texas Hold’em we have to be “all in”. This means changes in the delivery system that impact: providers (institutional and health professionals), insurers, and consumers. The hospital community can’t take a position that the solution is for government to pay for all uncompensated care delivered by the hospitals (there is not enough money in the system to do so).

Care has to be reformed – there needs to be an effective primary care system – so patients don’t go to the ED and hospitals become the most expensive site for delivery of primary care. Consumers need to be more responsive and their expectations need to be revised. The price tag to provide everyone with Lexus Care precludes such an egalitarian approach (I’m fearful GM will go under and the term “Cadillac Care” will no longer have any meaning – much like the term “Ice Box” – which only Rick Pitman uses).

Primary care physicians have to be empowered to coordinate care and not delegate to specialists (if you don’t believe it happens review NJ results in the Dartmouth Atlas). We need to learn from others and accept that we can’t get to reform overnight and change is painful and difficult. Most importantly we can’t get there without a unified effort.

Joe Morris, Mountainside Hospital
December 18, 2008 03:06
Patty Lubrano said...
Betsy; Thanks for starting this important dialogue!
December 18, 2008 03:27
Ann MacMurray said...
As a health care provider and as a citizen this is a topic that needs not only discussion but action. I would like to pose a question as to why we are looking goverment for healthcare reform. Why can't those of us in the health care business come together and devise a plan to reform health care. This plan may require new legislation, but lets face it if we would come together we are a large group. My feeling is that goverment run anything does not improve quality or efficiency. If anything things get more complicated and mismanaged. I am citizen and a nurse that would like to help in this process of reform. Can't we make an attemp before turning over the fate of our health care system to someone else to manage.
December 18, 2008 03:32
Donna Frappolli said...
Betsy, your comments were really interesting and well thought out. We'll see what Obama does. Hopefully he will not turn his back on his campaign promises like so many other politicians.
December 22, 2008 02:38
Rachel Nazarian said...
Have you invited our governor to read your cogent remarks concerning the economic impact of losing hospitals in a community?
Thank you for your insightful blog. Great idea!
December 22, 2008 04:20
George Pozgar said...
The mission of accrediting bodies is to improve the quality of care rendered in the nation's hospitals through its survey process.The JC, for example, is dependent upon the organizations it surveys to pay for those surveys. This means the JC needs to maintain happy customers, and in so doing, a conflict arises. How credible can a survey be when the JC is dependent on the organization it surveys for its financial survival? Further, organizations evaluate the performance of the surveyors. The survival of the surveyor in his or her job is dependent upon good evaluations from the contracting health care entity. Conflicting interests here encourage the surveyor to be careful about what he/she scores because of fear of retaliation by the organization and the JC. Is the JC in a Popularity Contest with other accrediting organizations or are they truly about Protecting the Public from harmful events that plague the nation’s hospitals.
August 12, 2009 11:59