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Making health care reform work
Panelists dish opinions on public option and more
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Four panelists from the health care field on Long Island addressed anonymous questions from the public on Tuesday night during a forum sponsored by the nonpartisan League of Women Voters.
Hospitals must care for every patient, whether or not they have insurance, Nassau-Suffolk Hospital Council's chief operating officer, Wendy Darwell, explained to the 50 or so people who had gathered at Harborfields Public Library, for an informative low-key evening, quite unlike some of the recent town hall meetings around the country that have exploded into shouting and at times physical altercations.
Billing and chasing down payments from insurance companies take up too much of health care providers' resources and health care reform must address that issue, Darwell opined. Having everyone or nearly everyone insured in the long term would benefit the financial stability of hospitals and the pharmaceutical industry. "In order for health care reform to work, we really are going to have some sort of sacrifice from all," she said.
Cheryl Hansen, a registered nurse and manager of the Women Veterans Project at the Northport Veterans Affairs Medical Center, noted that the patient data system there is accessible throughout the country . So her facility could easily retrieve the records of a California veteran, for instance. "The delivery of health care in my estimation … is excellent," she said, referring to the federally run veterans facility.
League of Women Voters moderator Janet Allen Spencer asked Hansen about the Veterans Administration's "telehealth" program. Telehealth allows doctors and nurses to treat veterans in their homes for physical and mental conditions by using devices that monitor their status, Hansen explained. "It gives the veteran tremendous security in knowing that somebody is there, even though there is a distance," she said. Hansen's facility serves all Long Island but is not easily accessible for many veterans.
Passed in 1965, Medicare was designed to keep people 65 years old and older from going bankrupt or on welfare, said Nelson Horchak, a grassroots organizer for the National Committee to Preserve Social Security and Medicare.
"It's a very efficient program," he said.
Mary Dewar, president of the Long Island Coalition for a National Reform Health Plan gave a chronology of health care reform through the years, going back to President Teddy Roosevelt's 1914 attempt. Most recently, President Barack Obama asked Congress to come up with a health care reform proposal. He asked that any plan include a few general principles, enabling people to keep any insurance they have, if they wish; preventing a person's pre-existing condition from limiting their access to health insurance; making insurance affordable and portable, meaning accessible anywhere in the country, and not adding to the national deficit.
Dewar said there are five different Congressional committees working on health care reform, but only one bill — HR 3200 or "America's Affordable Health Choices Act of 2009" offered by Rep. John Dingell (D-Michigan) — has had any traction.
In response to a resident's question whether privacy is a concern once patients' records go digital, Darwell said, "Absolutely. It needs to be very clear in federal law that you, as the patient, own your medical records, your information, about your health."
Just as the banking industry has come up with systems to keep records private, she added, the health care industry should follow suit.
Other questions from the public were as follows:
• What is the cost effect of people using emergency rooms as primary care?
"It's absolutely significant," Darwell said. To be effective, any health care system must use telehealth to manage people with chronic conditions. "If we had single-payer insurance, then everyone would be covered," said Dewar. "Everyone would have a card. Everyone could go anyplace they wanted to and they wouldn't need to be asked what their insurance is."
• Do you see the VA health care as a model for achieving universal health care? Hansen said she never thought of it as such before, but ventured that it would be an effective model. "I know, from my perception, we deliver excellent health care and we do it in a very organized, systematic way."
• If you were in charge of Medicare, what changes would you propose?
Horchak: "I would get into fraud control," along with increasing fees to primary care providers and capping malpractice payments. "Otherwise, leave it alone."
• Do high malpractice payments impact health care costs, and should there be tort reform?
Rep. Gary Ackerman (D-Roslyn Heights) recently informed Dewar that because tort reform and abortion are both controversial issues, they will be left out of health care bills and possibly be dealt with later. Two calls to Ackerman's Bayside headquarters for confirmation were not returned by press time.
• Will mental health care be included in health care bills?
It will be part of HR 3200, with no limitations and on par with physical health benefits, Dewar said.
• Would a public option increase the likelihood that private employers will stop offering insurance to their employees?
"That's what insurance companies are afraid of," Dewar said.
To assuage the insurance companies, Congress has stipulated that the public option would only be available to those who are uninsured, plus a few other exceptions, Dewar later said. Thus, companies of all sizes would continue to offer health insurance to their employees for several years to come. Under the current proposal, small companies could offer the public option in 2013; larger companies, in 2020, though that is subject to change.
• If we do pass health care legislation, how do we deal with the shortage of primary care providers?
Dewar suggested creating more parity between specialties and primary care. Darwell suggested providing incentives for nurses to become nurse practitioners or physician assistants.
Spencer then asked for the panel members' positions on a public health care option. Hospitals tentatively support the public option, Darwell said. "Our concern … is the way it would pay providers," she said. "Ultimately, the goal is that we get the maximum number of citizens of this country insured because hospitals believe, in the long run, that it's better for them and it's better for the quality of care."
Horchak said he wants a public option but is concerned about the details, particularly whether increasing coverage for more people would actually take away benefits from seniors.
"We're fighting for single-payer to the end," as opposed to the public option, Dewar said, but the organizations she represents are quite willing to accept the public option if that is all that's on the table.
• What do you hope to see citizens do in the process?
— Get involved, Horchak advised.
— Call your legislators, Dewar said.
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