Keynote speaker: Dr. Bruce White
Rx: Rationing or Reform?
Much like "all the king's horses and all the king's men" tried to do with Humpty Dumpty, Congress is about to try to put healthcare together …. again.
Members of Congress are faced with the urgent need to reform, repair or replace our dysfunctional healthcare system and will have to look at rationing (would Humpty be able to get only one new yolk and a whole new shell or just a patch?) and reforming by emphasizing prevention (teach eggs not to sit on walls).
A recent conference, Rationing or Reform? Overcoming the Perils of Health Care Today and Tomorrow, hosted by the Lipscomb University's Institute for Conflict Management, local healthcare leaders looked at some of the options on the ethical impact of changes and the effect they would bring to day-to-day decisions made by healthcare professionals.
Keynoting the conference were U. S. Rep. Jim Cooper and nationally known medical ethicist Bruce White, MD, chair of the Clinical Ethics Fellowship Program at St. Joseph's Hospital and Medical Center in Phoenix, Az.
Both agreed that conflict, within and outside the healthcare field, will intensify as resources become limited or redistributed among patient groups, geographic areas and providers.
With the institute's director, Larry Bridgesmith, serving as moderator, panelists discussing the topic "Conquering Perils in Operations" were Reginald Coopwood, CEO of Metro General Hospital; Bryant Witt, a healthcare compliance attorney at Miller & Martin; and Donna Gilley, who leads the regulatory compliance practice at Lattimore Black Morgan & Cain Healthcare Group, LLC.
Another panel focused on "Defeating Perils in Strategy and Policy," with panelists Kelvin Baggett, MD, CEO and vice president of clinical services at Hospital Corporation of America; Jack Faris, former CEO of the National Federation of Independent Business; and William Siren, head of the healthcare consulting division of Lattimore Black Morgan & Cain.
Noting that every hospital in the country has two or three similar cases, White chose one particular example from St. Joseph's case histories to illustrate the point that "free care has its price."
The case, featured in a front page story in the New York Times, documented the medical misfortunes of an illegal immigrant woman who had lived in the United States for 17 years. Although employed, she had refused to participate in the health insurance plan offered by her employer.
The woman presented at St. Joseph's Hospital for the birth of her sixth child with placenta percreta and, during the first 24 hours of her treatment required 268 units of blood products. The overall cost of treating her and her child, which amounted to more than $1.4 million, reflected one of the most controversial elements in controlling healthcare costs.
White quoted expert Bruce Patsner, MD, JD, who said "It would be difficult to find a situation more complicated and fraught with negative social intonation than that of repatriation of injured, undocumented immigrants back to their country of origin by U.S. hospitals."
White predicted than none of the healthcare plans proposed or already on the table could possibly succeed because not one includes provisions for the care of illegal immigrants in the country. "We can't do this," he added. "Think of what else could be done with that $1.4 million. We simply do not have enough money in the end."
White pointed out that almost 70 percent of people across the country have healthcare insurance. They bear the burden for the uninsured. He explained that in other countries, there is a fixed amount of money allocated for healthcare. "When they run out, that's it. In America, you can have as much healthcare as you can afford. The size of the pie is not fixed," said White.
White also noted that the American healthcare system is built on people of good will who are trying their best to show mercy. The problem is how. He added that currently "we take care of who shows up, and then share the cost."
A second keynote address was given by Rep. Jim Cooper, leader of the pack of the Blue Dog Coalition's Health Care Task Force, and one of Washington's most informed and most outspoken voices on the crisis. He has called for bipartisanship in Congress for passage of healthcare reform this summer.
Cooper said that between rationing and reform, "I choose reform," noting that he supports the Healthy Americans Act, which is about to be debated in Congress, calling it sensible, bi-partisan and already scored by the Congressional Budget Office.
Cooper pointed out that no other country in the world spends as much of their income on healthcare–and gets so little.
"Two thirds of America's financial problems come from overspending on healthcare," he said, adding that Americans seem determined to "get all the healthcare they can afford."
"What we have here is a failure to communicate. How can we spend so much and get so little?" he asked.
With passage of the Healthy Americans Act, he predicts the country would save $700 billion—and be healthier. The bill is "not a cut in spending; it just slows the growth of spending by 1 percent," he said, adding, "Rationing is not necessary; reform is necessary."
"We've turned this country into a giant insurance agency," Cooper said. "Rome is burning and these programs are unsustainable. We are bankrupting ourselves to overmedicate ourselves. People must assume some personal responsibility for their own health, mainly by fighting sloth and gluttony."
During the panel discussion, Baggett said, "What we have is not only a failure to communicate, but a failure to coordinate. We're providing care with incomplete information based on paper systems and patient recall. It's critical that we think about how to pull information from different 'silos' together so there is true coordination. The patient can serve as the vehicle to improve his care and health as well."
The cost of the various proposals before Congress is estimated to be about $1 trillion. In trying to make that number comprehensible, Cooper pointed out that a trillion seconds would be 32,000 years.
Faris referred to this statistic and said, "One trillion…how to comprehend it. Americans do not seem to get involved until there is an emergency. Since (most) Americans have health insurance, it's only an emergency to a few, but will be overwhelming soon. Then, it might be too late to turn around.
"Reform, not ration, should be the guideline."