COLLABORATION NEEDS TO REPLACE COMPETITION AMONG HEALTH CARE AND BUSINESSES

America's health care is in critical condition~~. We are~~ the only industrialized nation other than South Africa that does not provide access to basic health care to all our citizens. One of nine American workin~g families a total of 37 million people have no health insurance at all.

Medicaid was ~government's promise to insure pregnant women and infants and children who could not pay for coverage and were medically indi~gent. However, Medicaid barely covers 40 percent of the poor, and in Missouri a family of four cannot qualify for Medicaid ~if they earn more than $342 per month.

More working Missourians earn too much to qualify but cannot find or afford health care insurance. Some physicians refuse to treat Medicaid patients or treat them without payment because of the bureaucratic rules and difficulty in receiving payments.

Beyond original design

Medicare, the $110-billion program that started in 1965 with a $5-billion ~~bud~get, was desi~gned to provide health care for citizens~ aged 65-and-over with 90 percent of Medicare funds coming from payroll taxes. Currently there are about seven Americans under the ag~e of 65 for every one over 65. One of the s~even is unemployed and two are children, leavin~g four workers to support each elderly American. One of these four doesn't even have his own health insurance.

Moreover, the competitive, health-care-market-place approach threatens access to the poor except through hospital emergency rooms which are already burdened with providing trauma care and treating life-threatening illnesses without payment.

Status quo unaffordable

America cannot afford to support a status quo that does not work. It is time for health care reform not just in political talk but in action.

Necessary changes include reform of health insurance to make covera~ge more affordable for small businesses, expansion of public pro~grams (Medicaid) to cover the medical indi~gent, promotion of primary and preventative health care services and reduction in administrative costs and overhead.

Currently, Medicare pays Saint Francis 85 percent of what it costs to provide care. Medicaid pays even less of our hospital costs.

Charity care combined with deductions from revenue and bad debts amounts to a 40 percent write off. Thus, every employer providing health care benefits to their employees is subsidizing every employer who is not.

Vouchers: only part of answer

President Bush's plan to extend tax credits via vouchers to low-income Americans for purchasing basic private health insurance would provide access to coverage. But these vouchers should not be funded from cuts in Medicare and Medicaid. Taking from those who have too little, to ~give to those who have none at all, is not the answer.

One answer, supported by the American Hospital Association, is universal coverage for health care services either through the work place or through our expanded public sector Medicare/Medicaid programs. In this solution, private health insurance would play an important role, but only if it is more available and affordable for small employers than it is now.

Insurance companies such as Blue Cross and Blue Shield of Missouri, Inc., must continue to expand programs like Basic-Blue health insurance coverage to lower paid workers. They must also find ways to take care of the medically uninsurable.

Collaboration vs. competition

Ultimately, collaboration needs to replace competition, and a strate~gic partnership between health care and businesses, both who have an interest in the welfare of the community must be enjoined. This partnership should not be restricted by overly restrictive re~gulations. And ~administrative costs that consume needed health care dollars must be kept to a minimum.

Finally, ethical decisions have to be reached to deal with prevention of unnecessary care, treatment limits, unrealistic patient expectations and limits on final care. We must acknowledge that cultural values and social realities such as violence, drug abuse, AIDS, and homelessness are pushing up health care costs.

~~The need to develop an equitable,~ compassionate and financially viable health care delivery system is there. Will we wait for the National Government and National Health Insurance or will we develop local solutions to our health care crisis?

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John Fidler is President of Saint Francis Medical Center.