Uncompensated care, wasteful spending main factors in ethics of health care reform

Janel Shoun | 

 

America doesn’t need to ration health care, because the country is wasting so much money within the system today that plenty can be cut without harming the standard of care, U.S. Rep. Jim Cooper (D-TN) told a group of 80 local health care and business leaders who gathered at Lipscomb University for the second in a series of Conversations on Health Care.
 
U.S. Rep. Jim Cooper presents his take on the ethics of health care rationing.
Dr. Bruce White, medical ethicist, believes uncompensated care is the biggest challenge to reform.
Panelists Coopwood, Gilley and Witt discuss the ethical impact of health care reform.
Panelists Siren, Baggett and Faris take a governance approach to the question.
Rep. Cooper and ICM Director Larry Bridgesmith converse on health care issues.
Even the health care industry itself has told Congress they could save up to $200 billion on its own without harming patients, said Cooper, who has been an outspoken supporter of health care reform.
 
On the other hand, Dr. Bruce White, a nationally renowned medical ethicist, told the group that no health care reform will ever work unless it takes uncompensated care for the uninsured into account.
 
“In the end, we have to deal with the fact that there is not enough money,” he said, after noting that his home hospital, St. Joseph’s Hospital and Medical Center in Phoenix, Ariz., has spent $318 million in uncompensated care for illegal immigrants alone.
 
These were just two of the voices heard at Rationing or Reform? The Perils of Health Care Today & Tomorrow, a half-day conference on the ethics of health care reform held by Lipscomb’s Institute for Conflict Management as part of an overall effort to bring collaborative decision-making to health care reform.
 
The NASBA Center for the Public Trust and the Dean Institute for Corporate Governance and Integrity at Lipscomb’s College of Business co-hosted the conference, which was sponsored by Miller & Martin.
 
As health care reform in America moves closer to reality, conflict within the health care field is likely to blossom as resources are limited or redistributed among patient groups, geographic areas and providers.
 
Will health care reform mean longer lines in waiting rooms? Denial of life-saving drug therapy or surgical procedures? Less decision-making power for the patient? Rationing or Reform? explored how company executives, board members, attorneys and financial officers may deal with the ethical dilemmas that such operational changes bring?
 
In January, the Institute for Conflict Management convened a group of 70 high-level decision makers in regional, state and national health care providers for a summit on affordability and accessibility of health care. Co-sponsored by Vanderbilt Medical Center and Blue Cross Blue Shield of Tennessee, the summit produced a clear call to action: “Enhanced collaboration and immediate coordinated action is critical to support the delivery of quality, affordable and accessible health care.”
 
“Year after year, efforts to enact health care reform have failed because the leaders have been unable to build consensus,” said Larry Bridgesmith, executive director of the Institute for Conflict Management. “Litigation and partisan political approaches to driving change have not worked effectively, so the institute decided “to bring together the thought leaders in health care and take a different approach – a collaborative conversation that may lead to better outcomes.” 
 
The institute’s expertise in conflict management – a collaborative process to discover the underlying interests of competing parties – has been applied to a variety of fields (legal, religious, community, business and health care) in both individual and group settings, and would be of benefit to those working to shape effective and beneficial health care reform, Bridgesmith said.
 
The Institute for Conflict Management is the Mid-South region’s foremost authority and advocate of skills to minimize the costs of unresolved conflict. It is leading the state in shaping discussion of important issues facing business and society today.
 
During Tuesday’s conference, Cooper highlighted several ways the health care system already practices rationing, and said that consumers don’t seem to notice it. More services and bigger tax breaks available for the wealthy, doctors who refuse to accept indigent patients, lack of wellness coverage by insurance companies and Medicare services differing by region were among his examples. But what rationing consumers fear is limits on doctors’ or hospitals’ services or limits on insurance options, he said.
 
Local panelists at the conference included:
  • Dr. Kevin Baggett, director of Clinical Services at HCA, which operates 275 health care facilities across the nation.
  • Dr. Reginald Coopwood, CEO of Metro General Hospital, which expects to provide about $67 million in uncompensated health care in 2009.
  • Jack Faris, former CEO of the National Federation of Independent Business, bringing perspective on the burden of health insurance costs for small businesses.
  • Bryant Witt, attorney with Miller & Martin, who works with health care clients on compliance and regulatory issues.
  • Donna Gilley, head of the regulatory compliance practice at Lattimore Black Morgan & Cain Healthcare Group.
  • William E. Siren, leads the health care consulting division at Lattimore Black Morgan & Cain and has experience as a hospital administrator.
Faris noted that the average American may never become passionate about the need for health care reform until he understands how much his employer pays for his coverage and benefits.
 
Most employees focus on their net salary and don’t want to know about all the money that comes out before-hand, he said. This makes it difficult for employees to understand how overuse of the health care system and bad personal wellness choices end up costing the business as well as themselves through higher health care costs and thus higher insurance premiums.
 
Other panelists discussed the issue of doctors insulating themselves from accepting patients who are financial risks, the question of whether it is right to force people to purchase health care insurance, and the system used in other countries in which health care is on a pay-as-you-go system and care stops when the money runs out.