HCCD Report Maine 04605

GROUP SUBMISSION: HEALTH CARE COMMUNITY DISCUSSION

Held in Trenton, Maine – Tues., 12/30/08 (7:00 – 8:30 PM)
Moderator: Steve

General Questions:

Number of attendees: 6 (Including Moderator)

Note: Although we were able to have a fine discussion in such a small group, I have to express my frustration with the Health Care Transition Team’s unwillingness to help send invitations to community members. As someone who has participated in the past in events publicized through barackobama.com, I have been consistently impressed with how many community members attend in response to the very helpful invitation emails sent from that website’s database. (I did list my event on barackobama.com, but without the added clout of an ‘official’ email invitation I had no attendees sign up there.) I have to say that, given the low response to this Health Care Discussion, I am less likely to agree to host or moderate additional discussions in the future if the Obama Administration decides again not to help with invitations. Although I want to remain involved, as someone who is not a professional Community Organizer I feel I don’t have the resources to effectively create substantial events.

Personal Stories:

A) Doug, President of a local hospital, told of a hospital patient who was continually showing up at the Emergency Room looking ‘about to die,’ and so receiving a CAT Scan on each visit. Because the current system of record keeping (e.g., different hospitals keeping records with different computer programs) makes it time-consuming for hospitals – and especially for ERs – to check patient records before treatment, this patient was later found to have been given 30 CAT Scans over the course of time. That much radiation is highly dangerous. If not for an astute observation by an ER nurse at Doug’s hospital after several such visits, the excessive CAT Scans would not have been discovered. Effective computerized record sharing among hospitals would have helped prevent this dangerous over-treatment.

B) William expanded upon the problem of ineffectively computerized medical records by explaining how, although on many occasions he has diligently worked to make sure his paper records are transferred from one physician to the next, the size of the files apparently leads to the new doctor still having to ask about his medical history! Computerized record keeping that is simpler for busy physicians to access could prevent this problem, which the group agreed was common.

C) Doug also shed considerable light on the problems that hospitals encounter when too many hospitals in the area have advanced diagnostic equipment. His hospital was the first in the area to obtain a permanent MRI machine, and was originally able to offer MRIs at reasonable cost to patients/insurance companies. But, after two nearby hospitals – feeling they too should have all the cutting-edge equipment – obtained mobile MRI units, Doug’s hospital had to raise the price of MRIs to compensate for the decrease in their patient base by raising the cost of each MRI. In this case, poorly regulated competition amongst hospitals obviously led to unnecessary costs. (Doug further suggested that the state government – which at this time ostensibly provides such regulation – is overly lax in approving of medical equipment purchases by hospitals, as it merely requires them to show they can pay for the equipment. Such ‘rubber-stamping’ of purchases helps lead to this costly overabundance of equipment.)

D) Steve explained how a physicians’ lack of concern for patient costs, as well as the lack of transparency in these medical costs led to serious past financial difficulties. At a time when he was only working part time, a nephrologist ordered a battery of tests (including thyroid, pulmonary, and other areas he had never had problems with) in response to his history of kidney stones. The nephrologist explained that he believed in ‘treating the whole patient,’ and having been given the appropriate lab forms Steve was confident the tests would be covered by his insurance. After all, they were ordered by his doctor; he had been taught that doctors knew best what their patient’s needs were. However, only after having obtained normal results from all these tests, Steve found out that they were considered ‘unnecessary’ by his insurance company, and that now he owed the doctor far more money than he could afford. As the doctor’s office showed little appreciation for Steve’s financial troubles, he was forced to pursue a drawn-out process of dispute through his credit card company before his bill was adjusted.

As a result of this experience, Steve has made it a practice since that incident to call his insurance company to obtain costs and coverage information each time a physician orders what he or she considers a ‘routine’ lab test. Because neither the insurance company nor the labs seem to ever have a clear answer as to cost, this becomes a waste of time for everyone involved. On one particular occasion, after he was forced to decline having a test ordered by his doctor because he would have had to pay for it out of pocket, the doctor continually expressed his dissatisfaction with Steve as a patient! So, simply because he was trying not to overuse the system, Steve became alienated from the only specialist in this medical area who serves patients in his county.

E) Carrie extended the group’s conversation about the difficulties involved with trying not to sanction unnecessary medical tests. When she and her husband brought a relative to the emergency room after an accident, the ER staff ordered a CAT Scan. Carrie, though, was confident that she didn’t need one. After refusing the test, Carrie received a similar ‘attitude’ from the medical staff because she did not believe in buying something that was unnecessary. Iris confirmed from her own experience that it is difficult for a patient to question their doctor about the need for ordered tests.

F) Steve told of the problem his relatives, a 86 and 91-year-old couple, are currently having with the system. The wife is afraid to remove her husband from a nursing home even though he is getting close to being released by the medical staff. This is not because she does not want him at home; to the contrary, she wants to take care of him herself. But he is currently on a waiting list to receive Medicaid coverage. If he leaves before his Medicaid is approved, they will be ruined financially.

Summary of Responses from Discussion Questions:

Our group decided to concentrate for the whole session on question number 1 (“What does the group perceive as the biggest problem in the health system?”) This provided ample discussion, and we found anyway that we touched upon several of the other six questions in the course of discussing it. (Note: In answering Question 1, our group also demonstrated that we did not feel that one “biggest problem in the health system” could be pinpointed effectively. Instead, we all believe there are many overlapping, interconnected problems; so, for the health care system to be ‘fixed,’ all aspects need to be worked on at once. Fixing one problem in isolation might actually make other problems worse.)

One or more group members pinpointed the following problems:

A) LACK OF ACCESS
1) Health care should be a right. As of now, it is a privilege that many Americans do not have access to, because both medical professionals and insurance companies consider Health care as subject to the profit motive.

2) Health care is not something people should need to ‘gamble’ on by guessing on how much insurance coverage they need before they get sick.

3) Health care and ‘The Profit Motive’ do not mix!!!

B) EXCESSIVE ACCESS
A paradox given ‘A’ above, but true. Both patients and physicians are overusing the system; some doctors order too many tests and some patients access care they don’t necessarily need.

C) EXCESSIVE COST
1) Most cost is associated with the end of a patient’s life, when many of the procedures ordered may not be necessary (i.e., may not result in prolonging the patient’s life).

2) Competition amongst hospitals does not drive down prices; it actually leads to increased cost because each hospital has to cover the costs of its expanded machinery and services.

3) Competition as it now exists amongst insurance companies may drive down costs, but not in a morally acceptable manner. It is currently in the insurance companies’ best interest to provide less health care to those who need it most, because providing more care costs them more.

4) Even if the Obama Administration develops a quality health plan, excessive use of the system would drive up costs.

D) LACK OF TRANSPARENCY IN THE SYSTEM
1) Patients do not understand the cost of healthcare. It is too hard to find out from your physician or insurance company how much a procedure will cost before it is performed.

2) There is an essential ‘disconnect’ between costs and ‘the system’ followed by physicians and patients. Doctors order tests and their patients get them performed, and neither of them check on the costs of this until it’s too late.

3) The health care system – specifically how it’s paid for and covered – is too complex for the average person to understand.

E) THE EMPLOYER/ HEALTH INSURANCE ‘DISCONNECT’
Why are employers still responsible for an individual’s health care coverage? While this is a system that may have made sense in the past, when people had fewer jobs over the course of a lifetime, it doesn’t make sense any more.

Group members suggested the following SOLUTIONS:

A) ORGANIZE/ CONSOLIDATE REGIONAL HOSPITALS.
1) If hospitals in the same local area shared expensive diagnostic equipment effectively (e.g., only one hospital in a local area had a certain machine), the cost of diagnostic tests may go down.

2) Right now the state government is consolidating our school districts to provide for more efficient management; perhaps a similar process of consolidation needs to be applied to hospitals and physician offices.

B) SMART REGULATION
1) State governments should either be required to more strictly regulate which hospitals buy certain equipment.

2) Alternately, the regulation process could be taken out of government hands and given to some independent, non-partisan group.

3) Costs of services/diagnostic tests could be set higher by either one of the above regulators so that providers only allow patients who really need services to use them.

4) Insurance companies need to be more effectively regulated as well, to insure they are providing services to those who need them and covering costs/not trying to set premiums and coinsurance rates too high.

C) EDUCATION
1) Patients need to be better educated about how the health care system (e.g., coverage by insurance companies and costs of tests) works, so they can use the system wisely.

2) Also need better education on how to promote personal health/ PREVENATIVE HEALTH MEASURES. (I.e., education on patient responsibility for their own health.)

D) MAKE INSURANCE COMPANIES NOT-FOR-PROFIT COMPANIES.
Our group agreed that insurance companies aren’t the only problem. In fact, it might be possible – if they did not have to concentrate on the profit motive – to transform insurance companies from for-profit ‘gatekeepers’ into ‘quality control institutions’ that exist to make sure doctors don’t overcharge for services and patients don’t overuse the system. At this time, insurance companies might be uniquely situated to handle this task.

E) MAKE A GOVERNMENT-SPONSORED PLAN ‘TOO GOOD TO TURN DOWN.’
Using input generated by smart administrators as well as community discussions such as these, the Obama Administration might develop a government-sponsored health plan that is so good, people are actually drawn to leave their employer-based plans to join it. This would help remove the costly employer burden of providing health plans – but might require significant revisions to the current government health plan rather than just offering the one Congress gets ‘as is.’ (The problem to watch for here would be making sure that if more people use this plan, the cost of it doesn’t go up….)

F) REVAMP THE WAY COMPUTERIZED RECORDS ARE KEPT.
Currently, computerized medical record programs are trying to plug square pegs into round holes. We need software designers to understand that HEALTH CARE IS A CREATIVE SERVICE – not a purely quantitative system, like banking. Software designers might try the following:

1) Designing software that is able to present a ‘narrative,’ or qualitative, view of patient needs and doctor choices, rather than a purely quantitative, standardized view. Above all, the computer systems must be flexible, and written in a manner that reflects the range of rational choices available to providers and patients.

2) To do this, programmers might try designing a system where ‘tags’ are used in order to link many different services together, so that if a provider enters a medical condition they system would pull up all procedures that might be related to that condition. This way, doctors could avoid, among other things, performing tests that have already been done/overdone.

3) In order to help standardize computerized records, government could require a certain standard, quality software system to be used by all hospitals and doctors.

G) CHANGE THE WAY WE LOOK AT THE CONCEPT OF HEALTH CARE.
1) Right now, Americans are stuck in a system where providers see themselves as ‘businesses’ and patients see themselves as ‘consumers.’

2) This leads providers to concentrate on profit, and patients to concentrate on their entitlement to the full range of cutting-edge treatments that are available.

3) Both providers and patients need to look at the system more realistically. As health care is a human right, both providers and patients need to concentrate more on what each individual really needs – not how to perpetuate the ‘marketplace’ system of health care.