Flawed health care financing system is more about business than patients – Letter by Dr. Funke

Posted under Articles.

Originally published in Kingsport Times News December 4, 2011

Two months ago, Mountain States Health Alliance and CIGNA publicly announced their negotiations had failed and MSHA will no longer be a CIGNA provider after Dec. 31. Perhaps they both mean it. By rough guess, CIGNA covers 8,000 families in our community, so for Indian Path Hospital and the people of Kingsport this is a high-stakes contest.

As an independent physician, I have provided and received service at both Indian Path and at Holston Valley hospitals over the years. Both provide fine care, so this is not about quality.

Unless there is an agreement, many patients will have to leave the specialists and staff that are pulling them through cancer and heart disease. Pregnant women — some in their ninth month — will lose their obstetricians. Some will lose their family doctors who have treated their acute and chronic illnesses for many years, caregivers who guide them through major illness in an ever more complicated and fragmented system.

These relationships have both personal and monetary value and will be lost in less than a month. But it is not about doctors and nurses, and it’s definitely not about patients. It’s just business.

There is no blame to be laid upon Mountain States or CIGNA or those they represent. Those parties are performing as obligated to their boards and shareholders. The hospital system knows its bottom line, and CIGNA is negotiating lower costs for the local businesses they represent. Thankfully those local employers prefer to remain profitable by lowering their medical costs rather than through layoffs.

No, the problem is a flawed health care financing system that is far too business-centered instead of patient-centered.

As a result, employers are interposed between doctors and their patients. It is an uncomfortable place for employers, who are no more desirable in that position than government or insurance bureaucrats are.

CIGNA might come out a winner, but nearly everyone else stands to lose. Indian Path may have empty beds and underutilized operating rooms with ongoing expenses. MSHA’s physician practices will lose many patients. That may mean layoffs. Wellmont will retool as quickly and adequately as possible for a sudden increase in volume. As a result, longer waits for elective surgery may be anticipated, though without consequence to health.

However, longer waits in a more crowded emergency room could be dangerous. Even if all the affected patients’ information could be transferred to new doctors with a keystroke (it can’t), knowledge of patients and their illnesses takes time.

And hurried doctors and overworked nurses do make more mistakes. But this isn’t about safety.

What if there is an 11th hour compromise? That retooling effort will have wasted time and a lot of money.

These insurance-provider negotiations have proceeded here for years without going public. As medical costs rise four times faster than wages, this may just be the beginning. In more populated regions, insurance companies already trade their covered lives to the lowest bidder with regularity.

Proponents of the system will say that efficiency is being rewarded, but from the ground I’ll tell you that enormous waste is created in a highly trained workforce. And patients are not commodities to be traded like coffee beans and frozen orange juice.

Two myths are exposed by this event. The first is that private insurance provides choice. No one cares whether his insurance card reads UnitedHealthcare or BlueCross as long it will pay his choice of doctor and hospital, but insurance companies limit your choice to their exclusive networks. Fact: If you live in Kingsport today and your card says CIGNA, your choice has narrowed very substantially.

The second myth is that employers pay for most health care. They don’t. Individuals and households pay for ALL health care. It may be pumped through the government in payroll taxes, or directly through an insurance company, or through an employer in lieu of higher wages, but ultimately individuals and households pay for all health care in this country.

This event is not about quality, safety, or patient choice. It will save money for some in the short term, at the expense of wasted resources and unnecessary loss of jobs for others. What can be done? Very little now, but remember this when reform becomes a topic of discussion again, sooner if the current reforms are repealed, later if proven inadequate down the road. Employer-provided health insurance is a firmly entrenched but nevertheless outdated, flawed financing system.

Be open to better and simpler options from both progressive and conservative ideologies. Whether one believes health care is a societal responsibility or an individual one, employers can be relieved of the burden.

For now, I would hope those displaced patients’ next doctors and nurses will acknowledge their loss and promise to provide them the best care possible — until they are traded again.

– Dr. Robert H. Funke