A panel of physicians, a nurse practitioner and a representative from the insurance industry discussed health care financing and health insurance issues before a mixed gathering of about 125 young, middle aged and elderly men and women Monday evening in the Wilda Marston theatre at the Anchorage Loussac Library. The gathering was sponsored by the Conservative Patriots Group, a new organization seeking to organize the broad spectrum of several like minded, grass roots conservative factions into a unified force as advocates for liberty, smaller government and free market principles.
The presentation opened with the Pledge of Allegiance, a prayer, and introductions of the panel. The moderator, KBYR radio talk show host Glen Biegal, began the dialogue giving tribute to those in the audience who had shown an interest in the issue, while admonishing those who did not attend, as evidenced by the number of unoccupied seats. Mr. Biegal suggested that one possibility for the less than expected attendance was an ill-conceived perception that the debate was over. He cautioned against any declaration of victory at this point in the process, suggesting that those who seek to transform America will not be easily discouraged.
“No free lunch” was a theme that emerged early in the discussion while “cost shifting” from the government sector to the private sector was described as a major contributor to escalating health care costs. Health care was described as a finite resource that someone has to pay for, whether it is provided at a reduced cost or completely pro bono by the provider. At a reduced cost the number of patients a provider can care for is limited. At a minimum, the compensation received for an office examination must be equal to the average overhead cost of a visit. If it does not, then the provider is losing money on the visit, and in the aggregate loses a lot of money over the course of months and years. Eventually, the provider will go out of business if the circumstances continue.
Year over year, health insurance companies and health care providers are forced to adjust upward the premiums charged for insurance and the fees for medical services due to paltry Medicare payments. To mitigate the losses incurred by the providers for services provided to the elderly, the health care industry must increase premiums and providers must increase fees to recover the previous year’s losses, as well as to cover the current year’s anticipated losses.
Another option for the provider is to stop accepting Medicare patients. The appointment time slot is then available to a client able to pay or, at worst, can be used to catch up on some professional journal reading or to manage the small business he or she operates.
Additional upward adjustments to fees and premiums can be attributed to individuals who can not or will not pay for services rendered, leading to a shifting of these costs to the individuals and insurers who can and do pay. When the number of cost shifted payers and the number of non-payers overcomes the number of paying clients, the providers or institution delivering the service shuts down, as was suggested by one panel member who used as an example the number of hospitals recently closed in Southern California, New Mexico, Arizona and Texas.
Rationing of health care was presented as a given, with the primary question whether it will be a bureaucratic centered process or a process centered on the family. An example of the bureaucratic process was provided by a former air force fighter pilot who suggested that his family was given priority due to his position. The association of “who you are and who you know” was clearly identified as a legitimate phenomenon one could expect in a bureaucracy, suggesting that the average Joe will “hurry up and wait” while the important people will come and go as they please.
An important item of interest emerged from the panel that had less to do with the discussion of future national health care policy than with the impact of national health care policy on health care delivery in Anchorage today. Due to current national health care policy, the number of primary care providers who accept Medicare patients is rapidly declining, while the actual number of primary care providers is also declining. Furthermore, the projection was made that the problem will get worse due to the fact that the established physicians in Anchorage are fast approaching retirement age. Hence, the steady decline in primary providers is likely to continue while the number of senior citizens seeking primary care providers will continue to increase.
In a closing comment, one panel member commented that there is an unknown but significant number of senior citizens in Anchorage today who do not have a primary care provider. He went on to say that these individuals eventually end up in local emergency rooms to receive primary care, or worse yet as true emergencies that may not have developed into emergencies had they been cared for earlier in the process by a primary care provider. The emergency room he said, “is the least efficient place” to provide care to an aging population that is increasing in numbers. Unfortunately, the number of available and willing providers is also in decline, so the emergency rooms in Anchorage will inevitably come to resemble emergency rooms in the south western states, except there will be no question of the eligibility of those seniors waiting to be seen.
Tort reform, according to the panel, was less a factor in rising health care costs in Alaska when compared to the rest of the states, but still a problem none the less. Onerous legal requirements, such as long term record storage, were glossed over. The panel went to the heart of the problems regarding documentation, not necessarily to address the issue of defending themselves from malpractice claims, but ironically, to obtain compensation from the government for Medicare visits and, more profoundly, to avoid charges of fraud by the government.
According to the panel, the government contracts with an auditor who is compensated based on the number of infractions he discovers. Those infractions are not adjudicated in a process that is friendly to the medical professional, and the expense associated with defending against the charges are often potentially much more costly than the fine itself. As a result, the primary care provider soon discovers it easier to just pay the fines, and then to add this to the list of reasons why primary care providers are electing not to accept new Medicaid patients. Potential and real fines levied against the primary care provider for alleged fraud became another cost of doing business that motivated primary care providers to quit doing business with the government.
Overall, the presentation was informative and only overtly biased when the personal opinions of some of the panelists emerged. As one would expect, if a provider is accused of cutting off a patient’s foot, or taking out a child’s tonsils for the money, bias would be an understatement to describe the animosity such accusations provoked.
And finally, a telling moment during the presentation emerged when the panel was asked about the American Medical Association’s endorsement of the national health care plan. The laughter spoke for itself as the panel demonstrated a substantial disregard for the organization. In discussion, it became abundantly clear that the AMA had lost credibility and only represents about one out of every six physicians. Doctors, they suggested, have found that their interests are better served by membership in specialty organizations.