Health Care Reform Ideas

Dear Friends and Colleagues:
Attached an article from todays Miami Herald and a response in the form of a Letter to the Editor.

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Monday, January 15, 2007



Letter To The Editor


The interview with Brian Keeley, CEO of Baptist Health South, revealed a common misperception about how to solve America’s healthcare crisis. Locked into an ideological feud Democrats and Republicans either tout the benefits of a government-controlled system (Medicare For All) or the advantages of a free market system. Both sides are wrong.
Currently, local, state and federal government entities control 45% of all health care dollars spent and the number of uninsured is still rising, approaching almost one-third of all citizens in South Florida.
The so-called “free enterprise system” is riddled with mandates and regulations preventing an individual to obtain affordable insurance coverage and excluding those who suffer from even minor ailments.

A desired universal healthcare coverage should be based on the following:
1) Complete transparency and proper financial management of America’s domestic healthcare programs with full accountability of every tax-dollar spent;
2) Emphasis on prevention, individual choices and access to affordable medications;
3) Deregulation of the health insurance industry, removing insurance mandates and creation of an open national insurance market;
4) Comprehensive malpractice reform by establishing a medical court system and mandatory medical error reporting mechanisms, thereby guaranteeing the rights of patients and protecting the economic viability of the medical practitioner;
5) Creation of regional and national information sharing mechanism that allow for the immediate access to protected and safe guarded patient information, which will reduce the duplication of medical tests and avoid fatal medication errors.

America health care system is indeed in a deadly death spiral. We don’t need a Democratic or Republican solution. We need an American solution to provide health care for all.

Bernd Wollschlaeger,MD,FAAFP
Vice-President, Dade County Medical Association
16899 NE 15th Avenue
Miami,FL 33162
Phone: (305) 940-8717

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Posted on Mon, Jan. 15, 2007

Reversing U.S. healthcare's 'death spiral'
Brian Keeley, head of South Florida's largest healthcare company, discusses what to do about the nation's health problems and his own firm's role.
BY JOHN DORSCHNER
jdorschner@MiamiHerald.com
Brian Keeley is a mix of big-time business executive, philosopher and social innovator.

As chief executive of Baptist Health South Florida, he has created over the past 20 years a strong nonprofit system of five hospitals in affluent southern Miami-Dade County and the Keys at a time when many stand-alone facilities were going under or being sold to for-profit chains.

The system has become South Florida's largest nongovernment employer, with more than 11,200 workers, and the region's biggest healthcare firm, with $1.5 billion in annual revenue and a net surplus of $136 million.

Even with all this success, Keeley is concerned about America's conflicting views of healthcare. He succinctly portrays the tensions this way: ``We all want the absolutely best care, and we want someone else to pay for it.''

Like many industry leaders, he is convinced the country's healthcare system is in a ''death spiral,'' because the number of uninsured keeps rising. These people tend to skip primary care and end up in emergency rooms, where they run up big bills that they frequently can't pay, meaning hospitals must charge private insurers more to make up for these losses. That tends to make private health insurance less affordable, causing more companies to drop coverage, increasing the number of uninsured, and so on.

At times a bubbly cheerleader for new ideas, Keeley has announced recently two major initiatives: Baptist Health South Florida will favor using vendors who provide health insurance for their employees and it plans to provide affordable housing to attract workers.

Q: America spends twice as much on healthcare as other industrial countries, but we have the same or shorter life expectancy. Do we spend too much?

A: Yes, America spends a lot, for various reasons. One is the demands of the American consumer, but also we have a highly fragmented, highly inefficient system. And we're the only one of those [industrial] countries without a national, single-payer system.

Q: Where is one area where we cut back on costs and not hurt healthcare?

A: I think the administrative overhead and the lack of any integrated medical record system is a huge opportunity. We have so much duplication because we have these little silos of information in each doctor's office and every hospital. And no one talks to each other, and so consequently when the physicians order things they have no idea what other doctors ordered.

If we could come up with a single electronic medical record system that everybody shared, in my estimation we could save trillions of dollars because everybody is accessing the same information. . . . Everybody has to share. I am an extremely strong advocate of this.

Q: America has 45 million uninsured. Give me a short take on how to get people covered.

A: You can take the Democratic approach -- universal health [insurance], government control. Or you can take the Republican approach -- the free enterprise system. I'm for the free enterprise system.

The system will not self-correct right now. The market forces aren't aligned to make it self-correct.

I love what Massachusetts is doing with the mandate [requiring employers to provide insurance]. They have less of a problem. Their uninsured is 6 to 8 percent. In Florida it's 19 percent and in South Florida it's approaching 30 percent. . . . California is similar to what they're doing in Massachusetts, maybe a little more aggressive. California has about 20 percent uninsured, so they're similar to us. . . .

But I love the idea of a mandate: If you're going to play in the arena, you have to provide health insurance, and if you don't, guess who picks it up? We do because there's a cost shift to the private sector [in which private insurers have to pay higher premiums to cover hospitals' costs for treating the uninsured], or they're put on Medicaid rolls and we pay through our taxes. So a mandate makes tremendous sense to me if we're going to operate under the free enterprise system.

Q: Hospital gross charges are often three or four times what private insurers or Medicare pays. Why not just do away with gross charges?

A: The complex gross charge structure is incongruent, incoherent, indefensible. I will not defend the way hospitals charge, but we don't control that because we have all these impositions that are brought down on us by the federal government, which by the way pays us two different ways for Medicare and Medicaid.

And then every managed care company decides at its own discretion that they're going to pay us differently.

If we had a uniform, single methodology for reimbursing hospitals and physicians, we could save a huge amount of money, but it's beyond our capability to force that upon these payers out there, because they're the ones who set the rules. And we need to make this consumer-friendly, especially as we have this major shift to consumer-driven healthcare.

Q: Baptist Health South Florida has a very healthy bottom line, and insurance companies say you charge too much. As a nonprofit, how would you explain your surpluses?

A: Yes, we do have a profitable operation. And we're mission driven. We're faith based. And what that means is every single penny gets pumped back into the community for the benefit of the community, through charity care, through community service, through building new hospitals, like Homestead, which nobody would ever build down there because we're still losing $7 [million] to $10 million in Homestead.

We're making a huge commitment over there and in West Kendall [where Baptist plans another new hospital]. So it's not going in anybody's pockets.

By having a strong bottom line, we can also give a significant amount of charity care. People are eligible for charity if they earn up to 300 percent of the federal poverty level -- in contrast to Jackson, where it's up to 200 percent.