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EDITORIAL BY STEVE WOLFE, President & CEO of Indiana Regional Medical Center




As the 2012 Presidential Election race turns for the homestretch, the polls consistently show health care being a major issue for Americans as they head to the voting booths.  No wonder – perhaps you have heard the true story of a 64-year-old woman from Oregon who was diagnosed with cancer and prescribed chemotherapy by her doctor.  She later received a letter from the state of Oregon denying paying for her chemotherapy but offered to pay for hospice or physician assisted suicide!  While neither candidate is endorsing this type of approach to health care reform, the American people can sense change in the air.

The differences on the current health care law (Affordable Care Act) couldn’t be clearer between the candidates.  President Obama’s legacy is tied to the Affordable Care Act and re-election means full speed ahead on implementation of the 2,700 page law.  Governor Romney indicates that he will repeal the Affordable Care Act and replace it.

A few things to consider as you head to the polls:

1-      The change is real!

 In our political world of sound bites, spin and wordy speeches it can be hard to know just “how real” an issue is.  The health care system you have known since the 1960s is about to change!


2-      It will affect you!

To reduce the cost of health care, the impact will go much further than just cuts to hospitals, doctors and nursing homes.  Higher expenses and less care being delivered will be required.  At the end of the day, to spend less on health care, less care will be given (some of that care is unnecessary care). There will also be increased taxpayer governmental costs as a whole host of new regulators and corresponding offices are created and staffed.


3-      Good policy!

Major provisions of the law like expanding coverage, a focus on value-based purchasing, prohibition on denying coverage based on a pre-existing condition, etc., make sense and likely will be in any reform movement going forward regardless of who is in power.


4-      Medicare Panel is cause for concern?

A 15-member panel will be appointed to recommend ways to enact Medicare savings – including rationing of care – whose recommendations will carry the binding authority of law unless Congress quickly proposes counter-alternatives.


 5.    Bipartisan Effort

Nearly every landmark legislation of this magnitude (Social Security, Medicare & Medical Assistance, etc.) was accomplished with a Bipartisan effort.  This legislation was more than non-bipartisan; it was passed on a technical loophole to circumvent the legislative process before many members of Congress had an opportunity to read, study and understand all of its provisions.  As you will recall, even the Speaker of the House said “we have to pass the bill so you can find out what it says?”  As a result, it did not have real majority support at any point of the process.

6.   Expansion of Government versus Free Markets

A core problem for the current health care system is the lack of free market forces. The health insurance exchanges will likely move health care more toward expanded government role rather than free markets. The health insurance exchange could become a reality for many Americans as low penalties encourage employers to drop employer-sponsored health care.  The exchange products will include a federal product and tight parameters on other products will likely result in a reduction of covered benefits.  The Public Option that was so hotly contested and supposedly removed from the legislation may have backed itself into the law anyway.

7. Medical Malpractice Reform

 In this historic enacted system, where patients, hospitals, doctors and nursing homes will be asked to make major sacrifices, the legislation fails to include any real medical liability reform.  This reveals just how much money talks and the need for term limits in Congress are needed.  Defensive medicine is a daily reality and drives up the costs of necessary overutilization.

 8. Common Sense?

Many religious order hospitals and providers are conflicted over the laws that reach into the pro-life arena.  In a health care system that “needs” to reduce expenses, was it necessary to include this?

 9.  Population Health & Accountable Care –

The Affordable Care Act contains many similar ideas as the plan espoused by Hillary Clinton in the 1990’s—a plan that was soundly rejected by the American public.   I believe there is a need for a more careful approach to the matter of health care.  We do not need a repeat of the past.


Winston Churchill once quipped that Americans can always be counted on to do the right thing...after they have
exhausted all other possibilities.  It seems as if we’re determined to do just that when it comes to improving the healthcare delivery system in this country.  Two questions quickly come to mind.  Was the passage of the Affordable Care Act in 2010 simply an exercise of exhausting more possibilities before we finally “get it right?”  And, does the choice of president in November have further bearing on what happens to health care delivery moving forward?

Before we address those questions, I first would like to assert two truths that need to be acknowledged.  The first truth is that our healthcare system does need some major improvements, perhaps even a fundamental re-structuring of how we access and pay for medical care.  If we do nothing else, we need to reduce the costs of care and address the fragmentation within the system.  Quite simply, this means everyone—consumers, health care providers and insurers alike—will all have to share the burden of expense reduction.  For their part, consumers will have to contribute more to the cost of their employer-based health insurance or pay higher co-pays and deductibles.  Hospitals and physicians must learn to work smarter and reduce waste if we are to remain sustainable with reduced reimbursement.  And insurers will have to further reduce administrative costs and allocate more of every premium dollar to paying for actual claims.

The second truth is that all players in the healthcare delivery system are now involved in major initiatives to overhaul and refine our system—including reducing costs.  Hospitals, e.g., are participating in pay-for-performance programs which will potentially cause a loss in defined amounts of our reimbursement if we fail to meet specified outcomes or patient satisfaction levels.  The potential loss will increase each year as the bar for improved care delivery is raised.  In addition, health care providers are now actively engaged in refining their care processes to become more efficient, deliver better results and eliminate unnecessary waste.  We are actively adopting proven production techniques from business and industry in order to deliver better and less expensive service.  Improvement overhauls are alive and well in every sector of the health care delivery system.  But we have a long way to go.

So, back to our two questions—was the Health Care Reform Act an unnecessary over-reach and will this election have a major impact on further reform?  The reality is that no matter who wins the presidency this Fall, several of the components of reform from the Affordable Care Act have gained a tailwind and will continue to move forward.  Their train has already left the station and there’s no turning back. 

Nonetheless, your choice of a President can have a significant impact on how much more change we inflect upon a system already trying to right itself, and whether or not that change is desirable.  I would argue that we need to preserve three valued attributes about our existing healthcare delivery system no matter how much more change we try to impose on it.

Preservation of the physician-patient relationship:

When you reduce healthcare to its most essential core, it is about the interaction between a patient and her doctor.  Anything that compromises this bond is potentially damaging in nature.  The best decisions about your health care are made when an informed patient is free to discuss with her physician a range of treatment options and the liberty to pursue the one that makes the most sense within the means available.  And each case is different.  For example, the decision made between a relatively healthy 78-year-old male and his physician as to whether the patient should pursue a hip replacement may be different than the decision that is reached between a similar 78-year-old patient who also suffers from diabetes and congestive heart failure.  Both decisions will be in the best interest of the patient because they were borne out of honest interaction with their physicians.  There is a yet-to-be implemented piece of the Affordable Care Act, however, that threatens this sacred trust.  The law calls for the formation of Medicare panels that will impose arbitrary guidelines as to what classes of Medicare beneficiaries are eligible for certain procedures or levels of care, often guided by nothing more than a targeted budget reduction.   Such an implementation needs to be stopped at all cost.

Preservation of employer-based health insurance:

Most Americans are fortunate to have health insurance through their employers.  To be fair, this has often insulated employees from making informed and responsible decisions about healthcare because the employer pays a majority of their premium.  But many initiatives are now in place to increase shared responsibility, even if nothing more than requiring employees to contribute a greater share to the cost of the premium.  But this is one of the realities that we earlier mentioned.  Nevertheless, employer-based insurance has been a lynchpin in the financial structure of our delivery system and it needs to remain.  This long-standing principle could be threatened by the recent Supreme Court-approved mandate for all individuals to carry health insurance.   When enacted, there will be a troubling incentive for employers to pay a penalty and “opt out” of carrying health coverage for their employees, thereby handing them over to health insurance exchanges that will broker a multitude of health plans with defined premium levels from which individuals can choose.  The problem is with the insurers who will underwrite these plans.  While individuals will enjoy free preventive care, their out-of-pocket costs will increase due to higher co-pays and deductibles.

Preservation of the freedom to innovate:

There is reason why so many heads of state from other countries come to the USA when they need serious medical care.  For all our flaws, we still offer the most advanced and sophisticated medical care in the world.  And one of the biggest reasons for this is because researchers, pharmaceutical companies, medical device manufacturers and providers alike all deploy the engine of free enterprise to innovate and create new products and services.  All engage risk and reward equally, enabled by the prevailing forces at work in a free market system. If left unfettered, though, implementation of the full scope of a government-run health care delivery system will undermine the foundations of this valuable economic sub-system and will essentially bury the creativity that has characterized our advanced medical care system.

In summary, fundamental health care reform is already underway and admittedly several of its components were the result of the Affordable Care Act.  The health care industry is using these as a launching pad to even greater self-correction and improvement.  Let the industry continue without further tinkering.  Many yet-to-be implemented pieces of this legislation, as noted above, should never see the light of day because they will retard meaningful progress and development.  When it comes to the American health care delivery system, we don’t need to exhaust every possibility before we “get it right.”  We’re already moving in that direction.  Even Winston Churchill would agree with that.

Simply said, in my opinion, yes, health care spending is out of control and any plan to reduce spending will be painful and unpopular.  The current health care reform law is not the best plan for the future of health care and if implemented, it will cause a major, negative, long-term impact on:

* Patients’ care (in certain cases), level of benefits and cost;

* Hospital and physician ability to remain independent  whereby local leaders, who  represent the governing board of a full-size community hospital, are responsible for decision-making rather than a controlling system located elsewhere.

* Our Indiana County’s future economic viability.


Steve Wolfe

President & CEO

Indiana Regional Medical Center

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