Health-care fix needed, locals say

By Jerry Lynott jlynott@timesleader.comBusiness Writer

The way to health care reform has as many routes as participants in the industry targeted by the Obama administration and Congress for a major overhaul.

Lawmakers in the nation’s capital have been discussing the details of plans that have the common goals of providing insurance coverage for all and reducing the rate of increased spending.

The efforts, though slowed by partisan politics, are needed, said local observers with a stake in the outcome.

If nothing gets passed, the problems will worsen, said Frank Trembulak, vice president and chief operating officer of the Geisinger Health System in Danville.

“The cost of care will continue to rise,” Trembulak said.

More people will be without health insurance, the pressure on the nation’s health care system will increase, pushing it to the verge of collapse, he predicted. About 15 percent of Americans lack health insurance coverage, a figure that has swelled during the current recession.

What’s been working for the integrated health care company with its own hospitals, doctors and insurance plans, has been its variety of care programs and how it delivers them at a fixed price.

“We’re promoting a bundled approach to payment,” Trembulak said. “Payers are paying for an outcome, not units of work.”

Changing the payment mechanism from piecework to outcome is something to be considered nationally, he added.

From an insurance provider’s standpoint, what works is competition in the marketplace, said Anthony Matrisciano, a spokesman for Blue Cross of Northeastern Pennsylvania.

The nonprofit company, which serves nearly 600,000 customers in 13 counties in northeastern and north-central Pennsylvania, said hospitals, other insurers and providers support competition and oppose the government’s proposal to introduce a single-payer system. It would eliminate choice, reduce quality and fail to contain rising costs, the company said in a prepared statement.

“The most important part of any reform needs to be controlling health care costs,” the company said. “Based on the Medicare model, we do not believe a government-run plan will control costs.”

When the federal health care program for the elderly and disabled was introduced in 1965, President Lyndon Johnson’s administration projected it would cost $12 billion in 1990, BCNEPA said. The actual cost then was $110 billion and two years ago, the program’s benefits reached $426 billion.

Various estimates place the cost of President ’s plan at $1 trillion or more over 10 years.

Dr. Dan Kopen of Forty Fort pinpointed the current problems to Medicare’s creation and the resulting “huge infusion of federal dollars” into the marketplace and the concentration of industry participants on profit making.

“Before 1965, health care was simpler in its delivery and more focused on making the mission of better care to patients be the guiding principle,” said Kopen.

A member of the Northeastern Pennsylvania Health Care Reform Task Force, created by state Rep. Eddie Day Pashinski, Kopen advocated for change, but said the attention should be directed at universal access to high-quality care rather than universal coverage.

Special interest groups are driving the discussions in Washington, he said, while acknowledging that the task force has representatives from those groups including lawyers, hospital administrators, doctors and nurses, among others.

Special interests want quick action, he said.

But before rushing something through, lawmakers must take time to review what’s in front of them. “The best decision that Congress has made regarding health care reform was to delay a vote to allow a thorough analysis,” said Kopen.

Jerry Lynott, a Times Leader staff writer, can be reached at 570 829-7237.