Mt. Vernon Register-News

February 5, 2013

I have to chunk it down to understand


— Sometimes it takes me a while to get my mind around things. I have to just keep chunking it down until I get it real simple. I have reached the conclusion that our major problem with political corruption, unaffordable health care, unfunded pensions in Illinois and the majority of the ills we hear discussed daily boil down to a really simple fact.

The fact is: We have a major disconnect between who pays these people and who they serve. Think about this; “we” the taxpayers of this country, state, county and city, pay the salaries of every elected federal, state, county, official. We pay the salary of every administrative educator and teacher in the education system. Do you believe they work for who pays them, or do you think they know who they work for? Do you think they might think they work for their unions or other special interest groups? Think about it. Normally folks work for who puts the money in their pockets. That does not happen today! They work for who funds their campaigns and keeps them in office or negotiates their contracts. I am sure that readers see evidence of this daily as we observe the buying of votes from special interest groups by either agreeing to contracts the people paying them — you— cannot afford; or writing special deals into law for the special interest groups.

I could fill a book with examples, but I will just give you a few examples because I want to get back to the “Hospital War” in Boise Iowa. This situation tells a story about a major reason for high health care cost. Take a look at an excerpt from IMPRIMIS, a publication reprinted with permission from Hillsdale College.

“... government itself has become a strong force in elections: Much of the money funding the party of big government comes from inside the government through public employee unions — not to mention corporations, so many that receive a form of welfare from the government. This new development represents a dangerous corruption of the election process — and elections are the only means left to Americans to limit government. It’s a real problem.”

Take a look at how our country is changing and not for the better.

The annual portrait by numbers reveals sharp contrasts within any given year (most of the latest figures are for 2010 or 2011) as well as a moving picture of how the nation has been changing.

“More than 41 percent of births were to unwed mothers, for instance, compared with 33 percent a decade earlier. Student loan debt in households headed by a college graduate soared to $36,809 from $12,373 three decades earlier. Since 1982, the number of federal civilian employees rose by 160,000 while the number of state and local government workers swelled by 6.6 million.”

Middle class folks cannot afford to pay for everyone to work for the government with their taxes. Somebody has to make and sell a product or service to earn enough to pay the taxes that pay their salaries.

The Boise, Iowa, Hospital War that I wrote about recently deserves a little more ink. It really describes how actions by hospitals with captive markets in a city can influence the cost of health care with no improvement in quality. The article by Julie Creswell and Reed Abelson states that a little over half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or the smaller St. Alphonsus hospitals. St. Lukes’s has been on a buying spree, purchasing physician practices rapidly; everything from general practitioners to cardiologist to orthopedic surgeons. A lot of the independent doctors complain that both hospitals have too much power over every aspect of the medical pipeline, dictating which test and procedures to perform, how much to charge and which patients to admit to the hospital.

Now the smaller hospital is reported to be seeking an injunction to stop the larger one from buying more practices. They argue the hospital’s dominance was enabling it to drive up prices with procedures such as colonoscopies which quadrupled, and lab charges which went to three times as much as nearby facilities.

Now they are being investigated by the Federal Trade Commission and the Idaho Attorney General whether St. Luke’s has become too big as it increases prices and stifles competition. One estimate has Medicare paying in excess of a billion dollars a year or more for the same services simply because hospitals, citing higher overall costs, can charge more when doctors work for them. The report cited a primary care physician who said he could earn a $5,000 bonus for keeping patients in the hospital for less than three days in a lawsuit he filed this year. The Justice Department reached a $9.3 million settlement with Freeman Health System, a hospital group in Joplin, Mo., which was rewarding doctors it employed partly based on how many tests they ordered.

Hold on, you are not going to believe this one! One doctor recalled getting phone calls at night questioning why he had not admitted an older patient that he could have justified. He reportedly stated that “the pressure to admit was extremely high.”

Some of the doctors stated they are pushed to ignore what is best for patients by referring them to doctors working for the same hospital rather than specialists they knew would deliver better care. The report stated that some independent doctors would sometimes send patients 40 miles away because prices at St. Luke’s are 60 percent higher.

One comment really caught my eye. Dr. Julie A. Foote, a practicing endocrinologist in Boise, Iowa, for 18 years, remarked concerning the consolidation happening as hospitals continue to purchase doctor’s practices.

“I am not certain what all this means is that patients are getting cost-effective care, which is how the nation is painting this evolution; if this is better quality for less price, I want to see the less price.”

This article had many attached comments. Many of the comments were from doctors, administrators and other members of the medical community. Some were well thought out and others were really harsh and critical of items such as the new classification of doctor — “hospitalist” — now showing up as doctors working for the hospital because of a perceived lack of continuity.

I propose the following to you. If you believe as it is reported almost daily that the cost of health care is becoming prohibitive and that waste and fraud have permeated this industry, I ask you to take the time to read one comment of hundreds on the Boise article and please read the message at the web-site by Physicians for Health Care recommending a single payer system. I said single payer system; not to be confused with socialized medicine.

A comment from the article, “We have this system in my town and from my experience I’d say the smartest, best, and safest thing one can do for his/her physical and fiscal health is to stay away from hospital/corporate-owned doctors, and if at all possible ... also hospitals that practice the ‘hospitalist’ model. There is no such thing as continuity of care or communication there. The only time you’ll ever see ‘your own doctor’ is for a ‘wellness check-up’ at his/her office. If you get sick, you’ll see a lot of strangers who have too much on their minds to think thoroughly enough about your case, let alone about you as a person, to really know what’s going on with things in detail. Except for the occasional diligent nurse you might run in to, you and your families are on your own to manage your own illness and care and the physicians. If you’re lucky, you’ll have relatives who are health care professionals who can keep the doctors and staff informed and up-to-date on the details of your case, and pit-bull attorneys who can help you deal with the myriad of insurance details and errors you’ll spend scores of hours following-up on and fighting about. I don’t blame the doctors, it’s the system. And it’s badly broken.”