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Dear Chairman Stark,
I have been actively engaged in the field of healthcare
finance for nearly 30 years in the area of acute care hospital financial
management. As such, I have been responsible for rate setting, reimbursement,
budgeting, cost accounting and program analysis.
I note there appear to be only physicians on your panel.
I would suggest half your panel be comprised of nurses or hospital CEOs. They
are more familiar with what the real issues are. Most non-routine patient care
is delivered in hospitals. Physician offices are able to decline new patients
based on their insurance or lack thereof. Hospitals aren’t. Most that are not
for profit would not.
It is my opinion that the issue you describe as ‘healthcare
coverage instability’, commonly referred to as “access”, is one of financing. As
you know from having been active in healthcare reform for decades, a hospital may
not refuse, modify or curtail services to a patient based on ability to pay.
There are laws governing the transfer process as well. Therefore, if that were
the definition of ‘access’ I would suggest there is no problem.
In actuality, as you know, patients without insurance
often have no physician. They use the county hospital or local ER as their
primary care giver. Some say this drives up cost. I disagree. Efficiencies have
been in place for years to deal with the variability of acuity in ERs. Again, patients
are not turned away – so access is there, depending on your definition of the
term.
Your issue, I believe, is that there are higher levels of
care which you and I have access to that the uninsured and under-insured do
not. CMS initiatives regarding quality which are being extended to reduce
reimbursement will reduce this disparity. However, differences in quality of
healthcare are similar to the differences that exist in education, for example choices
between Harvard and the local Junior College, or between a ‘good’ high school
with a higher tax base and one in an economically deprived area. Similar
differences exist in the availability of legal representation in the criminal
justice system.
Your intent, I believe, is to suggest that the overall quality
of our country’s healthcare system would be improved (because you are
investigating its “instability”), if your committee can lay a foundation for
socializing healthcare. I caution you to look to the ‘models’ held up in the
past when this has been proposed. Canada’s healthcare access is far inferior to
ours. So is Great Britain’s.
As people of my generation approach the time in their
lives where healthcare is a priority, I think you will find that we will not as
quickly agree that more government will solve the few problems caused by
inadequate funding, and over-regulation. The introduction of PPS did not solve
hospitals’ problems, it only reduced their funding. Nor did the government’s
enabling the insurance industry to introduce Managed Care payment reduction
systems. Neither did the creation of CMS. Nor did the more recent doubling of DRGs from 500 to 1000 by CMS with different weights for Medicare and Medicaid.
Access for all patients to the highest quality of care is
a direct consequence of inadequate funding. Since it is not possible to fund
the highest quality of care for all, the only solution is to lower the quality
of care for those who have insurance. Socialization, of course is a dead end
from which there is no return. I ask that you not destroy our healthcare
industry by taking over complete control of it.
Thank you for the opportunity to share my opinions with
you.
Sincerely,
James Joseph Donbavand
6326 Diego Ln.
San Antonio, Texas 78253
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