"It's not a panacea": Local experts assess potential effects of healthcare reform

David Gulliver - posted 3:30 p.m. Tuesday, Jan. 12

The likely passage of healthcare reform will establish important principles, but people probably will see the costs before they realize any benefits.

That was the consensus of a panel of healthcare experts at “The Economic Impact of Health Reform,” a half-day discussion Saturday at Sarasota Memorial Hospital, sponsored by the National Medical Association and the Gulf Coast Medical Society.

State Rep. Keith Fitzgerald, the ranking Democrat on the House Policy Committee, said the bills in Congress are less comprehensive than many hoped.

"It really is not comprehensive health care reform. It's really health insurance reform with some cost management features,” he said. That will lead to more efforts to repeal some of the plan, because the costs will be upfront and the benefits a few years away, he said.

But the effort's success is that it establishes a principle that everyone is entitled to health care. By doing so, “we will cross the highest peak in the mountain range,” he said. And that should mean healthcare reform will survive. No government program aimed at the middle class has ever been taken away, he said.

Reform efforts could affect Sarasota County more than people realize, the panelists said. Dr. Mark Magenheim, who heads Suncoast Communities Blood Bank and a public health expert, reviewed data on how Medicare's soaring costs threaten to bankrupt the program by 2030 – important for Sarasota, where one-quarter of the population is Medicare-eligible and more than half are over age 55.

Sarasota County also has a surprisingly large population of uninsured – the same percentage of uninsured people as the city of Detroit, said Sarasota Memorial CEO Gwen MacKenzie, who previously ran a hospital system in that city.

“What does change is the face of the uninsured,” she said, noting now more working families have lost coverage. One result is that her hospital incurred $83 million in charity care and unpaid bills, she said.

MacKenzie cited the Massachusetts health reform effort, which requires all residents to purchase health insurance and established a system that reduces costs and restrictions. One byproduct is that it caused major financial losses at hospitals, including a $140 million hit at one facility.

“Most would agree Massachusetts is better off today,” she said, “(but) it's not a panacea. We need to go about this in a very cautious and careful manner.”

In the current version of the reform bills, states' cost for the Medicaid program, which primarily covers poor families with children and the disabled. Florida would incur 1 million to 1.7 million more Medicaid patients, a roughly 50 percent increase, she said. The state's Medicaid spending would rise $608 million to $1 billion.

Improving Medicaid funding is crucial, Fitzgerald said. Because it is so underfunded, most doctors don't accept it because it doesn't cover their costs. “Specialists cannot take part in Medicaid without taking a huge loss on each case,” he said.

Reforming the system of how we deliver care can only improve care slightly, said Brian Smedley, director of the Health Policy Institute of the Joint Center for Political and Economic Studies in Washington, D.C.

A study his group commissioned found that nearly one-third of health care spending stemmed from factors that disproportionately affect minorities – such as living in neighborhoods that are polluted or lack basic services like quality food markets. His group is pushing efforts – in one case backed by a hospital – to fix the problem “upstream” with measures such as bringing supermarkets to poor areas, thereby improving people's diets and reducing problems like obesity and diabetes.

That exemplified two conflicting philosophies at play in the healthcare debate, Fitzgerald said. Some say that people need to take responsibility for themselves and their health, and not leave it to government.

He agreed, but said improved healthcare requires a broader responsibility: "We need to encourage people to be responsible for their own behavior, but you have an obligation to build community and take care of your neighbors.”