Some Ohio leaders think ‘health care’ is lost in reform debate

It’s been a long, contentious August, when it comes to the health care reform debate. Today, members of Congress return to Washington to pick up where they left off before their summer recess. It’s shaping up to be an exciting week.

All signs point to getting the nation back to work on a “dramatic, comprehensive health care reform,” in the words of Oliver “Pudge” Henkel, chief government relations officer for the Cleveland Clinic. So we at MedCity News asked Ohio health care leaders a question: “Are we headed in the right direction with health care reform? Why or why not?” Here are their responses:

Barbara Belovich, executive director, Health Action Council Ohio:

“On a personal level, I am disappointed that the American public has an aversion for the complexity involved in this issue. If reform fails, it will be a failure in communication, not of ideas, as I believe the administration has most of that right.”

The board of  Health Action Council Ohio, a membership group for employers in the Cleveland and Columbus areas, believes that we should work to:

• Create a health system focused on creating the best outcomes for patients while controlling costs,
• Integrate care and take a team approach to care,
• Align incentives for quality of care and re-engineer our payment system to keep patients well, and
• Simplify complicated health insurance rules.

James R. Castle, president and CEO, Ohio Hospital Association:

“Hospitals support meaningful health care reform, provided it overhauls the entire system. Many conversations in Congress and around the U.S. have centered only on increasing access and coverage. True health care reform is a three-part process:

1. Increased access and coverage,
2. Delivery system reform,
3. Financing system reform.

Meaningful and welcome change is possible for all Americans if Congress can consider the big picture.”

Dr. Roy H. Thomas, president, Ohio State Medical Association:

“There are several problems with our current health delivery system that must be addressed. As such, the status quo has proven unsustainable. However, the current federal reform proposals, specifically the legislation in the U.S. House of Representatives (H.R. 3200), contain several deficiencies.

“H.R. 3200 does not include any medical liability reform measures, like those enacted in Ohio; contains payment cuts for imaging services; and bans new physician-owned hospitals and restricts those currently in operation. In addition, the proposal lacks adequate measures to improve consumer responsibility in controlling one’s own health care costs.

“The bill does have many positive aspects including increasing health insurance coverage to nearly 94 percent of legal, non-elderly U.S. residents and mandating health insurance market reforms such as eliminating coverage denials for pre-existing conditions. H.R. 3200 also provides a plan for fixing the flawed Sustainable Growth Rate formula. However, the specific plan contained in HR. 3200 is not an acceptable fix.

“Several federal health reform proposals, including H.R. 3200, contain a so-called “public option.” While the final definition of a “public option” remains in question, we are open to an alternative coverage proposal as long as that proposal does not force physicians to participate and/or mirror the government-run, and fiscally challenged Medicare and Medicaid programs. While we believe H.R 3200 is a positive step toward achieving comprehensive health system reform legislation, it is not, as written, an all-encompassing solution.

“The deficiencies that we have identified in this bill must be addressed prior to enactment of any final legislation. The OSMA continues to meet with members of Ohio’s Congressional Delegation to discuss improvements to the current health reform proposals, including H.R 3200.”

Steve Millard, A president and executive director, Council of Smaller Enterprises:

“Over the last several months, I think the process has scored high points for elevating the discussion and concern about the future of health care in America — however, in his address to the country in prime-time on the evening of July 22nd, President Obama changed the discussion. In that speech, he moved the focus to health insurance reform from health care reform.

“From that point on, the rhetoric of the White House and the focus of the country have been on how to change insurance to create more coverage. That ignores the fact that 70-80% of the health care dollar is going to the cost of care. Very little has been said about how we will get to real health care reform — i.e. reducing the cost of health care in our country to a point where the cost of care and the cost of insurance aren’t rising at unsustainable rates for the country’s citizens in need of access to care and its small business owners who seem to be the primary target for funding whatever expansion is created by reform.

“So until we turn our attention back to reducing the cost of health care and stop debating about financing insurance, I think we are heading in the wrong direction.”

William Considine, president and CEO, Akron Children’s Hospital:

“The reform challenge is so complex that a first step should be a pilot study, and I would like to see that pilot program for children. Children, many of whom are eligible for Medicaid coverage, are very often not enrolled and not receiving critical health care coverage when it can have the most impact. We lack a true national policy around health care for our children. We need to develop one, and, within that policy, set up a program that brings private insurers to the table, takes the money we are spending in Medicaid and spins that into a separate program for children.

“All children have a right to preventative and early childhood care — the care that keeps them well and out of our emergency rooms and other high-cost areas of our system. I think it’s doable and an initial focus on children is manageable, should receive bipartisan support, and could set the stage for larger reform for the adult population.”

Dr. Michael R. Anderson, interim senior vice president and chief medical officer, University Hospitals:

“I think we are because we continue to debate the issues. I think America having a healthy debate about what the role of government is in health care is a very important debate that we need to have. I think that President Obama has the right goals in mind, and that is, to continue to improve the quality and efficiency of care to patients in America, while at the same time decreasing the number of uninsured patients we have. Those are very important goals that we at this health care system strongly support.

“I think what you’re seeing now in the Congress and in the Obama administration is, the devil’s really in the details as to how are we going to pay for all of these goals. We at UH … are willing to become more efficient, to cost-cut as best we can. But the devil really is in the details of how we’re truly going to pay for the decrease in the number of uninsured and improving care.

“One of the things I find the most interesting is what’s called accountable care organizations — trying pilot programs where health care systems are rewarded for taking care of patients across a continuum. I think it’s the right focus. It’s not just the focus on payment for episodic care …  As a health care adiminstrator, that’s what I’m most excited to see play out.”

Thomas S. Campanella, associate professor and director, Health Care MBA, Baldwin-Wallace College:

“The current health care reform proposals have not focused sufficiently on initiatives that would optimize our health care system. Given the multiple societal demands on our tax dollars (e.g. education, economy, jobs, infrastructure, national defense, environment, public assistance, etc.), in order to have a sustainable health care system, we must focus on the underlying factors that impact health care costs. Our health care system is shaped by how we pay for services and what we pay for.

“Medicare, as the biggest payer, must fundamentally change how it pays for health care services. Medicare’s payment policies have been a major contributor to the high health care costs and inconsistent quality in the United States. Instead of having a payment system that would incent prevention, wellness, chronic care management, efficiencies, better quality and collaboration, we have a payment system that rewards overutilization, does not factor in quality of services provided, is fragmented and does not pay for preventive and wellness services in a meaningful and comprehensive way. These payment policies are also the major factor why we do not have a true primary care health care system in the United States.

“In order to seriously address issues of increased access, we must aggressively address the fundamental issues that impact cost and quality in our current system.”

Oliver “Pudge” Henkel, chief government relations officer, Cleveland Clinic:

“I think we are headed fundamentally in the right direction because although the American people seem to be in a bit of a quandary now … nevertheless, there’s a fundamental desire on the part of the America public to reform the health care system and make it work.

“The problems that has developed … is the media’s attention on the negative aspects of health care reform as portrayed during the August recess has had a big effect on how people feel about health care, and they have essentially lost what the fundamental message is. That’s why it is critical that the president … pull people back to the essentials of the argument and why it is that we need health care reform in this country.

“Reform is necessary fundamentally for two reasons: Health care has become unaffordable and Medicare is moving rapidly toward insolvency. That’s unacceptable. The quality of health care that’s being provided by all those enormous dollars is less than it should be.

“If we get the right start, and I think we will … it can lead to a health care system that has truly been reformed for the benefit of all us.”

[Photo credit: Carolyn Bunce]