Docs speak out on health care reform

The health care system in the United States is broken. That much was in agreement among those who spoke at a health care reform meeting hosted by state Rep. Josh Shapiro, D-153, Monday at Holy Redeemer Hospital.

“Clearly we’ve got to address access,” Holy Redeemer Health System President and CEO Mike Laign said. “Everyone should have access” to some measure of health care “so they are not living in fear.”

About 50 physicians, hospital administrators and other health care providers attended the forum aimed at soliciting input for a plan to meet President Obama’s goal of universal access to health care in the country. Shapiro was named last week as one of 32 state legislators nationwide to serve on the White House Team of State Legislators for Health Reform.

The team has been tasked with “helping the president shape the health care debate,” and subsequently to “cheerlead” for passage of a plan, Shapiro told the attendees, adding, “We are in the shaping phase.”

Access and cost are the two main factors, he said, with issues in Pennsylvania, such as not having enough primary care physicians and ob/gyns to treat people, shared by many states. Congressional committees are in the process of drafting legislation and “ideally a package will be ready to vote on in September or October,” Shapiro said.

“The current path — the status quo — in unsustainable,” he said. “The time is right; I need your help.”

Defensive medicine in the form of unnecessary tests, the high cost of medical school, the inflated cost of medical supplies and pharmaceuticals, patient expectations and philosophical issues regarding end of life care were among topics addressed by about 20 who offered comments at the meeting. Many also cautioned about rushing to formulate a plan.

The government “should be taking the time to do it right,” said Dick Jones, CEO of Abington Memorial Hospital.

Hospitals are working to reduce infection rates, unnecessary tests and hospital stays, but “something has to be done about tort reform,” Jones said. “We’re playing our part, but we can’t be totally nailed to the wall on cost,” he added, noting most hospitals make no margin on Medicare.

According to a report released in June by the Pennsylvania Health Care Cost Containment Council, hospitals’ operating margins dropped from 4.82 percent to 3.98 percent in fiscal year 2007-08, and almost a third of 169 that reported data had negative total margins.

Health care reform “is complicated” and “payment is not just the [only] issue,” said Dr. Arnie Cohen, chairman of obstetrics and gynecology at Einstein Hospital.

Patient expectations need to be changed, physicians need to be in charge of treatment and “tort reform belies everything we do in medicine,” Cohen said. “Everything we do every day is based on protecting ourselves.”

“Malpractice reform must be a key element of any reform. We need to resolve conflicts in a different fashion,” Montgomery County Medical Society President Mark Lopatin agreed.

“Patient expectation is huge … that to me is the core of the problem,” he said. Access is not impacted just by a lack of insurance, “there are backups due to unnecessary tests.” Defensive medicine costs about $100 billion a year, he said.

More than 80 percent of health care costs occur in the first and last years of people’s lives, said a doctor who identified himself as a nephrologoist who works at seven hospitals. There is a need to determine how to address “extra care for those who have no chance of survival.”


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