|
Congressman
Doug Ose commenced the healthcare forum in Sacramento, California by
welcoming all the participants. Thanking all of the panelists
and speakers, Congressman Ose provided background information to the
three upcoming panels. He stressed the importance of taking back
the panelist feedback, as well as participants’ comments, and
applying them to both the state and federal level. While noting
the daunting process of addressing healthcare concerns in the new
millennium, he reminded everyone that it is real people, with real
worries, who need real healthcare security. Finding a few
solutions to solving the issue of providing high quality healthcare at
a reasonable price was his goal, and he urged everyone to participate.
Mr. Jack Kavanagh, an Emmy Award winning host of California Capitol
Week on KVIE, moderated all three panels.
OPENING
REMARKS
Speaking on “Health Care in America:
Understanding the Challenge,” Dr. Tom Nesbitt of the UC Davis
Medical Center discussed his work in the Telemedicine Program.
Basically, telemedicine uses video-based conferencing and images to
send information among the healthcare community for second opinions on
individual health cases. Telemedicine has opened up many fields
to a grander scale, including the home health and rural arenas.
So far there are 3,000 telemedicine consultants and a nationwide
interest in the field. The practice has received coverage on
msnbc and a nightly news program.
Dr. Nesbitt saw the
telemedicine technology as capable of bridging the gap between the
healthcare provider and the public, especially for rural communities.
For example, a skin lesion can be photographed on a rural patient and
sent to an expert urban specialist without having to travel or take
time off work. Telemedicine can address cultural and language
barriers. With cost and quality improving, along with funding
for telemedicine, it definitely seems the wave of the future.
Dr. Nesbitt warned, however, that telemedicine must be a supplement,
not a substitute for healthcare needs. So far telemedicine has
been popular with those who use it, including the mental health field.
It seems telemedicine may be the best bet for redistributing the
medical expertise throughout the country - offering not perfection,
but a lot of promise.
PANEL ONE:
Challenge of the Uninsured
Dr. Don Young, Chief Operating Officer and
Medical Director of HIAA, provided an overview to the “Challenge of
the Uninsured” panel. Many factors lead to the problem of the
uninsured, including affordability, an insufficient safety net for the
poor and near poor, and inconsistent tax policies. Healthcare
costs and premiums are on the rise, especially for pharmaceutical
expenditures. Medicaid is declining among the poor, thus
increasing the amount of uninsured. We need to lower costs,
decrease mandates, provide broader care, and improve the public health
system in general. Cost effects the public and private market,
as well as employers footing the health insurance bill. A viable
solution must incorporate both the government and the private sector.
While pushing
recipients off Welfare, these individuals typically move into
low-paying jobs. The problem comes, then, when businesses are
not picking up the health insurance tab. One problem with the
CHIP program and Medicaid involves a simple lack of signing people up
for the coverage – it’s out there, people just don’t know about
it. Other times employers will pick up the majority of a health
insurance tab, but employees will not pay the remaining 10% or 20% of
the cost, for example, claiming they do not need health insurance.
In addition, language barriers, rural distance, and an abundance of
paperwork thwart success with these programs.
49% of small
businesses in California do not provide any healthcare to their
employees. This becomes a bigger issue as California
has the lowest managed care premiums in the nation. Tax
incentives in this area could help the problem. Communicating
with the employers to educate employees about the possible healthcare
programs available must happen. It becomes hard to create
federal legislation that is appropriate for each state’s situation,
even though legislation is needed. Forcing health insurance onto
individuals must be done through the employer. On the other
hand, for twenty years California law has mandated that automobile
drivers must own car insurance, yet 25% of California drivers still do
not. Employers, in general, need to know the healthcare options
that are available. Better communication, then, proves essential
to healthcare reform.
Panelists included Ms.
Jeanne Cain of the California Chamber of Commerce, Mr. Duane Dauner of
the California Healthcare Association, Mr. James Shelby the President
of Sacramento Urban League, and Mr. Steven Tingus from the California
Foundation for Independent Living Centers, Inc.
PANEL TWO:
Medicare/Seniors Health
The second panel stressed living a healthy
lifestyle to prevent problems, as opposed to relying on prescription
drugs to solve health issues retroactively. They felt that
raising more money for HMOs was a crucial issue, as well as reforming
the bureaucracy involved in making healthcare decisions. These
HMOs also need more of a presence in rural, underserved areas.
When HMOs are lost, people return immediately to Medicare and must
then pay a certain amount of money each month. Other
participants pointed blaming fingers at the government for not always
paying its bills. The high cost of prescription drugs, a
multitude of lengthy forms, and fraud ranked among the three major
healthcare concerns of this panel. The possibility of getting
sued for fraud due to not knowing about a minor aspect of the required
paperwork worried many doctors.
A shortage of nurses,
temporary clinics offering no accountability, and not allowing nurses
and doctors from other countries to work in the United States were
specific California concerns. More communication also seemed
necessary, as seniors just do not know what options are out there that
they can receive. A need for local control, as opposed to
looking to the government for all the answers also seemed to be the
consensus. Essentially, everyone involved in the healthcare
field needs to make compromises and come up with a solution together.
Education about the importance of saving for the future was also
addressed. For example, the average senior only has $30,000
saved. This amounts to enough for only one year in a nursing
home. Instead, people are investing in material things, such as
boats or new homes, when they do not even have the money in the bank
to buy these things now. In the end, it seemed America offers
the best medical healthcare in the world, but only to those who
possess great healthcare coverage.
Panelists included Ms.
Pauline Clancy, Councilwoman at Vacaville City Hall, and Ms. Denise
Yuponce of Eskaton Village Senior Connection. Mr. John Kehoe,
Executive Director of the California Commission on Aging, provided the
overview.
PANEL THREE:
Delivering Health Care in Rural and Urban Areas
Ms. Sandy Smoley provided an overview to the
rural health panel, sharing her expertise as a nurse and former
Secretary of Health and Welfare for the State of California.
Rural health possesses different problems such as being far away from
healthcare facilities. Often ambulances are used for minor
events, taking them away from their emergency intent and adding a high
cost. Telemedicine is helping alleviate the system, although it
is still not ideal. The challenge of obtaining and keeping
healthcare workers in rural areas is hard. Often urban areas
provide more money, education, and cultural opportunities. Rural
areas sometimes make these healthcare providers feel like they are
alone. Healthcare costs have become huge, leaving many
doctors’ practices downsizing or going under. Reduced Medicare
and MediCal is adding to this problem, even though the government’s
budget is now balanced. The Balanced Budget Act of 1997 was the
biggest cut to healthcare and Medicare, shifting the money to the
private sector. A change to the stigma of accepting government
money for healthcare needs to occur as California actually returns
money from some of its programs to the government.
Currently, 10% of
doctors face bankruptcy. Regulations and restrictions have
become obscene. For example, two authorizations are now needed
just to get an x-ray completed. Previously no authorization was
necessary. Some doctors actually prefer providing rural
healthcare, as they get to know the patient and their families better.
Perhaps, some speculated, this results in better healthcare practices
when the doctor knows the patient’s medical history, family support
system, and may even know where they go to church or run into them at
the grocery store or little league game. Certainly, this is
better than merely knowing their heart shape or mole size.
Others pointed out this could just be a difference between a family
practice and a specialty practice.
There seems to be more
accountability in a small community, as everyone hears about mistakes
or big events within the healthcare community. Losing a doctor
in a rural area also affects the community more, as it is typically
hard to recruit a young doctor to work there. Other areas are
not defined as rural when they should be, simply because they’re
located in L.A. County, for example. Therefore, these rural
areas do not receive the proper amount of reimbursement that they
should be entitled to. While rural areas are advancing
technically, we cannot always depend on DSL lines, for example, to be
in place. Seniors, too, are rapidly growing more technological
so we should gear more information for them through this network.
Panelists included Ms.
Elizabeth Abbot from the Health Care Financing Administration, Dr.
Ernie Johnson of the Sacramento Ear, Nose, & Throat, and Dr. Bill
Davis from Winters Health Clinic.
KEYNOTE
SPEAKER:
Congressman Bill Thomas (CA-21) provided the
keynote address, sharing his expertise as chairman of the House
Committee on Ways and Means, Subcommittee on Health. He pointed
out the current healthcare system as flawed with a deep need for
revamping. He also noted particular weak areas, such as
anti-trust and government healthcare programs to a gap among
generations about how to deal with healthcare. He urged people
to investigate the role between death and dying versus the quality and
quantity of life.
Congressman Thomas
also noted that people consume as much healthcare as people are
willing to pay for. At the end of the year, for example,
citizens will buy a new pair of eyeglasses whether they need them or
not if their coverage will pay for it. Feeling they have the
right to do this because of their contribution to their health
insurance tab, they actually waste money on a service they did not
need. Congressman Thomas urged a change in society’s values
about healthcare. Many consider healthcare coverage a right,
when in fact employers are oftentimes the ones paying for the
coverage. In terms of prescription drugs for seniors, the
government must come up with a plan to help seniors out with this
cost, as private healthcare plans do.
Again, focusing
on healthcare ethics, Congressman Thomas received applause when he
condemned the dishonor of healthcare professionals who keep quiet
about their own mistakes. Sharing these mistakes could thwart
the same problems from happening again in the future. The role
of military hospitals also must become revamped and mainstreamed or
they will have to specialize in geriatrics due to an aging population.
Creating standards and tests to stop allowing people to ignore away
the failure of many government- based programs seemed a viable
solution. Adding a managed care component appeared the most
crucial aspect of revamping the system according to Congressman
Thomas. Only fixing something when it’s broken, without
preventive medicine, made Medicare seem just like old-fashioned
intervention.
|
