It’s time to pass re­form bill, a reader says—but not all read­ers agree

Modern Healthcare - - News -

Suit­able spe­cialty

As a ju­nior re­searcher who is in­ter­ested in the phe­nom­e­non of the emer­gence of new hospi­tal or­ga­ni­za­tional forms, I agree with all the points you dis­cussed in your ar­ti­cle “Up-siz­ing the com­pe­ti­tion” (Feb. 15, p. 22).

I have writ­ten my dis­ser­ta­tion on spe­cialty hos­pi­tals and much of my re­search is fo­cused on this or­ga­ni­za­tional form.

It is re­ally amaz­ing to me how the gov­ern­ment can in­ter­fere to ban a po­ten­tially more ef­fi­cient com­pet­i­tive form of hospi­tal, just to pro­tect gen­eral hos­pi­tals, even though 75% of th­ese gen­eral hos­pi­tals are al­ready get­ting fa­vor­able treat­ment through tax ex­emp­tion.

Much more re­search is needed on physi­cian-owned spe­cialty hos­pi­tals and ban­ning them pre­ma­turely is an in­sti­tu­tional fail­ure that will se­verely hin­der cur­rent ef­forts to

im­prove the qual­ity and ef­fi­ciency of our health­care sys­tem.

Mona Al-Amin As­sis­tant pro­fes­sor Health Ser­vices Re­search Man­age­ment and Pol­icy Depart­ment Uni­ver­sity of Florida Gainesville

Trade ar­ro­gance for needs

I think the action of our leg­is­la­tors is de­plorable—in­clud­ing the Obama ad­min­is­tra­tion (“Obama to an­nounce di­rec­tion on re­form next week,” Mod­ern­Health­, Feb. 26).

Congress has com­pletely mis­man­aged the Medi­care and Tricare pro­grams, which are so im­por­tant to the health and well­be­ing of Amer­i­cans who have served our na­tion so long and so well. Our rep­re­sen­ta­tives had:

■ More than a year to re­peal the Medi­care pay­ment for­mula and en­sure the se­cu­rity and sta­bil­ity of the pro­gram. In­stead, Congress has aban­doned pa­tients who rely on Medi­care and Tricare for their health­care.

■ Par­lia­men­tary pro­ce­dures of­fer no ex­cuse for the harm they are caus­ing th­ese pro­grams.

■ They need to stop play­ing po­lit­i­cal games with pa­tients and physi­cians; the sus­tain­able growth-rate for­mula should be re­pealed once and for all.

Pres­i­dent Barack Obama needs to ex­change his ar­ro­gance for thought­ful con­sid­er­a­tion of the needs of the peo­ple he rep­re­sents.

Pa­tri­cia L. Brew­ster CEO South­ern Or­thopaedic Spe­cial­ists At­lanta

It’s time

I find those sug­gest­ing any­thing other than mov­ing for­ward promptly on re­form heart­less. We have been at this for decades. Tens if not hun­dreds of thou­sands have died un­nec­es­sar­ily be­cause they could not af­ford care. Count­less fam­i­lies have suf­fered bank­ruptcy be­cause of un­fair health­care cost bur­dens. Ev­ery other civ­i­lized coun­try in the world has fig­ured this out. It’s way past time for the U.S. to pass ma­jor re­form.

I pray that the Se­nate and Congress will gain com­pas­sion, put aside their power-grab­bing show and work out a re­form bill.

Ned Simp­son Ann Ar­bor, Mich.

Get it to­gether

I f the Democrats are se­ri­ous about pass­ing a bi­par­ti­san health­care sys­tem over­haul law, they need to in­cor­po­rate the fol­low­ing into the cur­rent bill:

■ Tort re­form: Ar­bi­tra­tion is com­mon to most con­tracts, so why not health­care ser­vices?

■ Sale of in­sur­ance across state lines: Com­pe­ti­tion can’t hurt.

■ All “spe­cial deals” must be culled out of the bill.

■ Hon­est fund­ing mech­a­nisms: Strong use of ded­i­cated rev­enue streams.

■ Be will­ing to limit the bill to a more man­age­able scope, dras­ti­cally re­duc­ing its com­plex­ity.

If the Repub­li­cans are se­ri­ous about help­ing to solve the U.S. health­care cost is­sue they will:

■ Con­cede that the cur­rent health­care in­sur­ance sys­tem needs se­ri­ous im­prove­ments.

■ Al­low that the cur­rent bill ap­pro­pri­ately amended could be ac­cept­able to every­one.

■ Help iden­tify ways to fund health­care ser­vices for those who can’t af­ford it on their own.

The Democrats are jus­ti­fi­ably leery of the time de­lay nec­es­sary to se­ri­ously con­sider Repub­li­can health­care re­form ideas. The Repub­li­cans are push­ing to “start from scratch.”

This is over­play­ing their hand; they should be will­ing to con­cede that the main com­po­nents of the cur­rent Se­nate bill would be re­tained and im­proved. It is a shame be­cause to­gether they could craft a bill that fur­thers every­one’s goals of in­creased ac­cess to health­care cov­er­age and re­duced long-term costs.

Frank Ya­cano Bos­ton

Utopia, Wash­ing­ton, D.C.

I think it is ab­so­lutely ab­surd to al­low the sus­tain­able growth-rate vote to come three days be­fore a po­ten­tial 21.2% cut in Medi­care al­low­ables. I am ap­palled that a panel can spend six to seven hours talk­ing about health­care re­form, and leave thou­sands of health­care work­ers won­der­ing if there will be lay­offs be­cause of this cut.

It is ex­tremely ar­ro­gant on the part of the pres­i­dent and his col­leagues (both Demo­crat and Repub­li­can alike) to waste one day of Se­nate leg­isla­tive work to dis­cuss health­care re­form without the SGR even be­ing dis­cussed on the Se­nate floor. I find it in­sult­ing that af­ter two weeks off (one be­cause of poor weather) the Se­nate feels it can treat peo­ple this way.

Th­ese politi­cians bet­ter start to re­al­ize that the peo­ple are fed up with their ar­ro­gance. What do they care when they have all the health­care perks that no one else has? They had bet­ter get out of their ivory tow­ers and en­ter

the state of re­al­ity the rest of us are liv­ing in.

What’s so dif­fer­ent about an in­sur­ance com­pany deny­ing cov­er­age for a surgery when the pa­tient is on his/her way to the op­er­at­ing room? The clock is tick­ing, but I do not re­ally be­lieve that we all use the same clock as those who are in the utopia of Wash­ing­ton, D.C.

Tom Dahl Chief ad­min­is­tra­tor Or­tho­pe­dic Cen­ter of Florida Fort My­ers

The ruse they use

This pro­posal is merely the lat­est ruse by the White House and the Demo­crat­ic­con­trolled Congress to get a bill—any bill— passed, so that they can use it as a camel’s-nose-in-the-tent for fur­ther one-sided ini­tia­tives.

The re­forms that we need most are: Do away with the use of pre-ex­ist­ing con­di­tions as a means of elim­i­nat­ing “prob­lem” pa­tients/in­sured lives for in­sur­ance com­pa­nies. Pro­hibit pol­icy rescis­sion by in­sur­ance com­pa­nies. Re­move the re­stric­tions on how health in­sur­ance can be pur­chased, i.e., per- mit out-of-state com­pe­ti­tion. We ab­so­lutely must have tort re­form to con­trol health­care costs. Fi­nally, we must get “real” and elim­i­nate deals be­tween the Obama ad­min­is­tra­tion and spe­cial-in­ter­est groups—which are all pigs at the trough.

Den­nis Tol­man Rexburg, Idaho

What a waste

When is some­one at CMS go­ing to do some­thing about the com­pletely ar­bi­trary and very waste­ful three-day oblig­a­tory acute-care stay to qual­ify for skilled-nurs­ing-fa­cil­ity place­ment (“MedPAC press­ing plan to re­coup pay­ments,” Mod­ern­Health­, March 1)?

As a for­mer acute-care hospi­tal di­rec­tor of uti­liza­tion man­age­ment turned health­care at­tor­ney, it is one of the many waste­ful and ar­chaic re­quire­ments in the Medi­care pro­gram. Nu­mer­ous pa­tients are “ad­mit­ted” to the hospi­tal, placed on in­tra­venous an­tibi­otics, and then re­mark­ably dis­charged to a skilled-nurs­ing fa­cil­ity af­ter the third qual­i­fy­ing day.

(And make sure one of those three days isn’t listed as “ob­ser­va­tion sta­tus” be­cause then the CMS may qual­ify the en­tire skilled-nurs­ing-fa­cil­ity stay.) This well-in­ten­tioned man­date no longer works in to­day’s health­care sys­tem.

Frank E. Biedak Lawyer Taun­ton, Mass.

Com­pet­i­tive spirit

Com­pe­ti­tion is good. Is any­one old enough to re­mem­ber when AT& T had a mo­nop­oly (“AMA re­port finds lit­tle com­pe­ti­tion in in­sur­ance mar­ket,” Mod­ern­Health­, Feb. 23)?

Un­for­tu­nately, to­day the choice of the plan is higher cost with fewer ben­e­fits. Good for some in­sur­ers, whereas re­turn on in­vest­ment is in­creased. How­ever, fewer ben­e­fits at a higher cost are bad for the in­sured need­ing care.

Gabriel Mitchell Chicago

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