dirty
EOG Master
Here is a good read about this from my Local Paper...
Movie renews debate on whether government should run health care By DEBBIE GILBERT
The Times
GAINESVILLE
<hr noshade="noshade" size="1" width="100%"> <!-- ########### BEGIN STORY AND PHOTO TABLE ############# --> <table valign="top" align="right" cellpadding="5" width="210"> <tbody><tr> <td> <!-- ########### BEGIN PHOTO COLUMN ############# -->
Scott Rogers The Times Brittany Chambers, left, and Pattie House work at their desks of the Longstreet Clinic's accounts receivable and registration department Thursday afternoon. They are part of the clinic's large administration contingent that deals with the complicated insurance policies.
Scott Rogers The Times Donna Parks talks with an insurance provider over the telephone Thursday afternoon in the Longstreet Clinic's claims resolution department.
Now showing
The Michael Moore film "Sicko" is not currently playing in Hall County. Here are the nearest theater locations; call for showtimes.
AMC Theatres Colonial 18: 825 Lawrenceville-Suwanee Road, Lawrenceville, (404) 816-4262
United Artists North Point: 6500 North Point Parkway, Alpharetta, (770) 663-0770
GTC Beechwood: 196 Alps Road, Athens, (706) 546-1011
</td> </tr> </tbody></table>
Last week's debut of filmmaker Michael Moore's latest documentary, "Sicko," has reignited debate over whether the United States should have universal health care.
Moore argues that there should be a single-payer, government-run system, which theoretically would solve two problems. It would cover the 45 million Americans who don't have health insurance, and people would no longer have to depend on their jobs for medical coverage.
But many doctors in Northeast Georgia think it's a bad idea.
"Single-payer health care would do more harm than good. It's not going to do anything to contain costs," said Dr. Jack Chapman, a Gainesville ophthalmologist who is president-elect of the Medical Association of Georgia.
Dr. Rodney Smith, a Gainesville general practitioner who helped start Hall County's Health Access Initiative for the working poor, believes America "desperately needs" universal coverage.
"But the tricky aspect is how exactly that gets done," he said. "I certainly do not want a single-payer system, because customer satisfaction would go down. In a government-run system, there's less of a work ethic."
Even physicians who hate insurance companies aren't thrilled about the feds getting involved in health care.
Dr. Gary Berliner runs a Dawsonville clinic that circumvents insurance by offering affordable care on a cash basis.
"I'm not a big fan of insurance companies, because 'managed care' means 'no care,'" he said. "But with a national health system, you'd be back to managed care. Both systems work by denying service."
Doctors wary of 'socialized medicine'
Berliner said he has worked as a physician in Germany, Israel, and England, all of which have some form of nationalized care.
"In all of those places, the political elite gets the best service. No one else gets care except on the most basic level," he said.
In the admittedly one-sided "Sicko," Moore travels to England, France, Canada, and even Cuba to show how the citizens of those countries benefit from having free access to care. But critics say he fails to mention the disadvantages of such systems.
In Canada, the situation has gotten so bad that it's driving doctors to practice elsewhere, including Gainesville neurosurgeon Dr. Bruce Nixon, who moved to the United States in 1993.
"Things aren't perfect in the U.S., but it's far better than what Canada has," he said. "Doctors there have no control and aren't able to do anything for their patients. It's basically wait-in-line medicine. You have to wait up to two years for joint replacement surgery."
Far from being egalitarian, Nixon said the Canadian system is just like any other: The richest people will always find a way to get top-notch care.
"When I was practicing in Toronto, people who did not want to wait eight months for an MRI would go down to Buffalo (New York) or to the Cleveland Clinic and pay for it themselves," he said.
Nixon said in Canada it's illegal for a citizen to pay for an MRI, even if they can afford it. The national health system does not allow any for-profit competition.
"My brother is an ophthalmologist, and he's still practicing in Canada," Nixon said. "He's thought about leaving, but he's been able to make a living because he can do procedures (such as laser eye surgery) that aren't covered by socialized medicine."
Nixon said the single-payer model has been "a disaster" in every country that has tried it.
"It doesn't work," he said. "It bankrupts the government, and people abuse it."
Insurance: government-controlled or for-profit?
Instead of the government automatically insuring everyone, Nixon believes people should be forced to take responsibility for their health care.
"Most people who are uninsured got into that situation because of poor choices they've made," he said. "We require people to have car insurance; why can't we require them to have health insurance?"
Nixon would get no argument from Gary Reynolds, a Gainesville insurance broker.
"I don't deny that there are a very large number of people without insurance. But many can afford it and choose not to buy it," he said. "I can't see changing the system for everybody just because a few people have a need."
Reynolds believes a nationalized system would create "an awful mess."
"You would have no control over who your doctors are or what kind of care they provide," he said. "The current system may be confusing, but that's the way competition is."
Moore contends that the problem with health care in the U.S. is that it's profit-driven. And on that point, Berliner agrees.
"If your sole goal is to make a profit, you end up with managed care, which rewards doctors for doing less and saving the company money," he said. "The goal should be good patient care."
Yet governments, which are always constrained by budget limitations, could end up rationing care in much the same way. And Chapman believes the overall quality of care would be worse.
"There's no consumer choice, no incentive for innovation or cost control," he said. "And individuals aren't motivated to improve their health because they're not paying the bill."
Smith said in some cases it's clear that competition has been beneficial.
"Northeast Georgia Medical Center now has the No. 1 heart center in Georgia," he said. "That would not have happened if we had had to apply to the state for money. So we do want to preserve the free-market system."
ER substitutes for universal coverage
But while the Gainesville hospital has won awards for its cardiac and cancer programs, it also struggles to treat thousands of uninsured patients who come to the emergency room with non-life-threatening ailments.
A federal law requires hospitals to treat everyone who comes to the emergency department. And that, in essence, has become America's default national health care system. But it places the burden on hospitals instead of on taxpayers.
Cathy Bowers, spokeswoman for Northeast Georgia Medical Center, said the hospital spent $47.5 million on uncompensated care last year.
When the number of uninsured patients exceeds the number who are able to pay, a hospital begins hemorrhaging money. That's a major reason why Atlanta's Grady Memorial Hospital is in danger of closing.
"There are currently about 1.7 million uninsured Georgians, and it costs more than $1.2 billion a year to care for them," said Glenn Landers of the Georgia Health Policy Center at Georgia State University.
"But it's not clear that we would save any money if there were a single-payer system. There's a lot of debate right now about whether health care is a right. And even if it is a right, how much are we willing to pay for it?"
What critics of government-subsidized health care may be forgetting is that the U.S. already has two enormous, federally run programs: Medicare and Medicaid.
"People who have Medicaid are actually in pretty good shape (in terms of access to care)," said Smith. "And Medicare is better now that it has prescription drug coverage."
Smith believes universal coverage might be achieved by a combination of public and private plans.
"We should keep the free market, but have a way for government to step in for people who can't get any other coverage," he said. "If Medicaid could act as the insurer of last resort, I think it could work. It's such a large organization that its overall administrative costs are low."
Insurance plans mired in bureaucracy
But Medicaid, a joint state/federal insurance program for the poor, has its own difficulties.
"There's a lot of negatives in dealing with only one or two payers, because you're at their mercy if something goes wrong," said Mimi Collins, chief executive officer of the Longstreet Clinic, Gainesville's largest multi-specialty practice. "But purely from an administrative standpoint, having a single payer would make things easier."
Last year, Gov. Sonny Perdue decided to move Georgia's Medicaid patients into a system much like the HMOs (health maintenance organizations) that privately insured patients are familiar with.
Collins thinks these CMOs, or "care management organizations," may be worse than having a single-payer system.
"The problems we've experienced with the Medicaid CMOs have been a nightmare," she said. "There is a lack of accountability. I spend so much time on the phone arguing with insurance companies, and I'm very frustrated. And now we're starting to see the same issues with the new Medicare Advantage plans."
Any benefit that government-run health care might have offered is negated if it's outsourced to for-profit companies, Collins believes.
"My fear is that instead of a universal payer, the government would just privatize their programs to existing insurance companies," she said.
So Longstreet would still have to employ a whole office full of people to handle insurance claims.
"I've got a team that does nothing but Medicaid, another team that does nothing but Medicare, and another that does commercial insurance," said Collins. "That's because the rules for each type of insurance are different, and it's so complex that no person can be knowledgeable about all of these plans."
Collins said the people who are employed by the insurance plans don't seem to know much, either; she said she encounters incompetence in both government-run and private programs.
"There are some good trends in the insurance industry, such as wellness programs and evidence-based medicine," she said. "But there are still a lot of reforms that need to be made. The only way a physician gets paid is by doing something, which has led to overutilization of tests and procedures. They still get paid very poorly for an office visit."
Equal coverage for everyone?
Chapman agrees that there's not enough incentive for preventive medicine. But he thinks that in order to take responsibility for their health, patients need to understand how much things actually cost.
"Right now, health care is like flying on an airline," Chapman said. "Your plane ticket may have cost twice as much as the guy's in the seat next to you. Similarly, you can have two people with appendectomies at the same hospital and one paid a lot less, because their plan negotiated a better deal."
That inequity, with patients being penalized for having bad insurance or no insurance, is what leads advocates like Moore to call for universal coverage.
After all, not everyone who lacks insurance is just too lazy or cheap to buy it.
"This is a big problem for people who get sick with cancer or another serious disease and lose their jobs," said Collins. "Then they can't get coverage anywhere."
Reynolds acknowledged that it's tough for people with pre-existing conditions to get affordable insurance. But he said that's an unavoidable fact of life in the United States, where the health care industry is big business.
"Insurance plans can't accept everyone who applies," he said. "If they did, the companies would go bankrupt."
And, as Nixon has pointed out, budget crises are already occurring in countries that have tried to provide coverage for every citizen, regardless of their health status.
But local doctors still hope that politicians will be able to come up with a solution that balances compassion with financial stability.
"Sometimes, you have to look at what's the right thing to do," Smith said.
Contact: dgilbert@gainesvilletimes.com; (770) 718-3407
Originally published Sunday, July 8, 2007
Local News - gainesvilletimes.com
Movie renews debate on whether government should run health care By DEBBIE GILBERT
The Times
GAINESVILLE
<hr noshade="noshade" size="1" width="100%"> <!-- ########### BEGIN STORY AND PHOTO TABLE ############# --> <table valign="top" align="right" cellpadding="5" width="210"> <tbody><tr> <td> <!-- ########### BEGIN PHOTO COLUMN ############# -->
Scott Rogers The Times Brittany Chambers, left, and Pattie House work at their desks of the Longstreet Clinic's accounts receivable and registration department Thursday afternoon. They are part of the clinic's large administration contingent that deals with the complicated insurance policies.
Scott Rogers The Times Donna Parks talks with an insurance provider over the telephone Thursday afternoon in the Longstreet Clinic's claims resolution department.
Now showing
The Michael Moore film "Sicko" is not currently playing in Hall County. Here are the nearest theater locations; call for showtimes.
AMC Theatres Colonial 18: 825 Lawrenceville-Suwanee Road, Lawrenceville, (404) 816-4262
United Artists North Point: 6500 North Point Parkway, Alpharetta, (770) 663-0770
GTC Beechwood: 196 Alps Road, Athens, (706) 546-1011
</td> </tr> </tbody></table>
Last week's debut of filmmaker Michael Moore's latest documentary, "Sicko," has reignited debate over whether the United States should have universal health care.
Moore argues that there should be a single-payer, government-run system, which theoretically would solve two problems. It would cover the 45 million Americans who don't have health insurance, and people would no longer have to depend on their jobs for medical coverage.
But many doctors in Northeast Georgia think it's a bad idea.
"Single-payer health care would do more harm than good. It's not going to do anything to contain costs," said Dr. Jack Chapman, a Gainesville ophthalmologist who is president-elect of the Medical Association of Georgia.
Dr. Rodney Smith, a Gainesville general practitioner who helped start Hall County's Health Access Initiative for the working poor, believes America "desperately needs" universal coverage.
"But the tricky aspect is how exactly that gets done," he said. "I certainly do not want a single-payer system, because customer satisfaction would go down. In a government-run system, there's less of a work ethic."
Even physicians who hate insurance companies aren't thrilled about the feds getting involved in health care.
Dr. Gary Berliner runs a Dawsonville clinic that circumvents insurance by offering affordable care on a cash basis.
"I'm not a big fan of insurance companies, because 'managed care' means 'no care,'" he said. "But with a national health system, you'd be back to managed care. Both systems work by denying service."
Doctors wary of 'socialized medicine'
Berliner said he has worked as a physician in Germany, Israel, and England, all of which have some form of nationalized care.
"In all of those places, the political elite gets the best service. No one else gets care except on the most basic level," he said.
In the admittedly one-sided "Sicko," Moore travels to England, France, Canada, and even Cuba to show how the citizens of those countries benefit from having free access to care. But critics say he fails to mention the disadvantages of such systems.
In Canada, the situation has gotten so bad that it's driving doctors to practice elsewhere, including Gainesville neurosurgeon Dr. Bruce Nixon, who moved to the United States in 1993.
"Things aren't perfect in the U.S., but it's far better than what Canada has," he said. "Doctors there have no control and aren't able to do anything for their patients. It's basically wait-in-line medicine. You have to wait up to two years for joint replacement surgery."
Far from being egalitarian, Nixon said the Canadian system is just like any other: The richest people will always find a way to get top-notch care.
"When I was practicing in Toronto, people who did not want to wait eight months for an MRI would go down to Buffalo (New York) or to the Cleveland Clinic and pay for it themselves," he said.
Nixon said in Canada it's illegal for a citizen to pay for an MRI, even if they can afford it. The national health system does not allow any for-profit competition.
"My brother is an ophthalmologist, and he's still practicing in Canada," Nixon said. "He's thought about leaving, but he's been able to make a living because he can do procedures (such as laser eye surgery) that aren't covered by socialized medicine."
Nixon said the single-payer model has been "a disaster" in every country that has tried it.
"It doesn't work," he said. "It bankrupts the government, and people abuse it."
Insurance: government-controlled or for-profit?
Instead of the government automatically insuring everyone, Nixon believes people should be forced to take responsibility for their health care.
"Most people who are uninsured got into that situation because of poor choices they've made," he said. "We require people to have car insurance; why can't we require them to have health insurance?"
Nixon would get no argument from Gary Reynolds, a Gainesville insurance broker.
"I don't deny that there are a very large number of people without insurance. But many can afford it and choose not to buy it," he said. "I can't see changing the system for everybody just because a few people have a need."
Reynolds believes a nationalized system would create "an awful mess."
"You would have no control over who your doctors are or what kind of care they provide," he said. "The current system may be confusing, but that's the way competition is."
Moore contends that the problem with health care in the U.S. is that it's profit-driven. And on that point, Berliner agrees.
"If your sole goal is to make a profit, you end up with managed care, which rewards doctors for doing less and saving the company money," he said. "The goal should be good patient care."
Yet governments, which are always constrained by budget limitations, could end up rationing care in much the same way. And Chapman believes the overall quality of care would be worse.
"There's no consumer choice, no incentive for innovation or cost control," he said. "And individuals aren't motivated to improve their health because they're not paying the bill."
Smith said in some cases it's clear that competition has been beneficial.
"Northeast Georgia Medical Center now has the No. 1 heart center in Georgia," he said. "That would not have happened if we had had to apply to the state for money. So we do want to preserve the free-market system."
ER substitutes for universal coverage
But while the Gainesville hospital has won awards for its cardiac and cancer programs, it also struggles to treat thousands of uninsured patients who come to the emergency room with non-life-threatening ailments.
A federal law requires hospitals to treat everyone who comes to the emergency department. And that, in essence, has become America's default national health care system. But it places the burden on hospitals instead of on taxpayers.
Cathy Bowers, spokeswoman for Northeast Georgia Medical Center, said the hospital spent $47.5 million on uncompensated care last year.
When the number of uninsured patients exceeds the number who are able to pay, a hospital begins hemorrhaging money. That's a major reason why Atlanta's Grady Memorial Hospital is in danger of closing.
"There are currently about 1.7 million uninsured Georgians, and it costs more than $1.2 billion a year to care for them," said Glenn Landers of the Georgia Health Policy Center at Georgia State University.
"But it's not clear that we would save any money if there were a single-payer system. There's a lot of debate right now about whether health care is a right. And even if it is a right, how much are we willing to pay for it?"
What critics of government-subsidized health care may be forgetting is that the U.S. already has two enormous, federally run programs: Medicare and Medicaid.
"People who have Medicaid are actually in pretty good shape (in terms of access to care)," said Smith. "And Medicare is better now that it has prescription drug coverage."
Smith believes universal coverage might be achieved by a combination of public and private plans.
"We should keep the free market, but have a way for government to step in for people who can't get any other coverage," he said. "If Medicaid could act as the insurer of last resort, I think it could work. It's such a large organization that its overall administrative costs are low."
Insurance plans mired in bureaucracy
But Medicaid, a joint state/federal insurance program for the poor, has its own difficulties.
"There's a lot of negatives in dealing with only one or two payers, because you're at their mercy if something goes wrong," said Mimi Collins, chief executive officer of the Longstreet Clinic, Gainesville's largest multi-specialty practice. "But purely from an administrative standpoint, having a single payer would make things easier."
Last year, Gov. Sonny Perdue decided to move Georgia's Medicaid patients into a system much like the HMOs (health maintenance organizations) that privately insured patients are familiar with.
Collins thinks these CMOs, or "care management organizations," may be worse than having a single-payer system.
"The problems we've experienced with the Medicaid CMOs have been a nightmare," she said. "There is a lack of accountability. I spend so much time on the phone arguing with insurance companies, and I'm very frustrated. And now we're starting to see the same issues with the new Medicare Advantage plans."
Any benefit that government-run health care might have offered is negated if it's outsourced to for-profit companies, Collins believes.
"My fear is that instead of a universal payer, the government would just privatize their programs to existing insurance companies," she said.
So Longstreet would still have to employ a whole office full of people to handle insurance claims.
"I've got a team that does nothing but Medicaid, another team that does nothing but Medicare, and another that does commercial insurance," said Collins. "That's because the rules for each type of insurance are different, and it's so complex that no person can be knowledgeable about all of these plans."
Collins said the people who are employed by the insurance plans don't seem to know much, either; she said she encounters incompetence in both government-run and private programs.
"There are some good trends in the insurance industry, such as wellness programs and evidence-based medicine," she said. "But there are still a lot of reforms that need to be made. The only way a physician gets paid is by doing something, which has led to overutilization of tests and procedures. They still get paid very poorly for an office visit."
Equal coverage for everyone?
Chapman agrees that there's not enough incentive for preventive medicine. But he thinks that in order to take responsibility for their health, patients need to understand how much things actually cost.
"Right now, health care is like flying on an airline," Chapman said. "Your plane ticket may have cost twice as much as the guy's in the seat next to you. Similarly, you can have two people with appendectomies at the same hospital and one paid a lot less, because their plan negotiated a better deal."
That inequity, with patients being penalized for having bad insurance or no insurance, is what leads advocates like Moore to call for universal coverage.
After all, not everyone who lacks insurance is just too lazy or cheap to buy it.
"This is a big problem for people who get sick with cancer or another serious disease and lose their jobs," said Collins. "Then they can't get coverage anywhere."
Reynolds acknowledged that it's tough for people with pre-existing conditions to get affordable insurance. But he said that's an unavoidable fact of life in the United States, where the health care industry is big business.
"Insurance plans can't accept everyone who applies," he said. "If they did, the companies would go bankrupt."
And, as Nixon has pointed out, budget crises are already occurring in countries that have tried to provide coverage for every citizen, regardless of their health status.
But local doctors still hope that politicians will be able to come up with a solution that balances compassion with financial stability.
"Sometimes, you have to look at what's the right thing to do," Smith said.
Contact: dgilbert@gainesvilletimes.com; (770) 718-3407
Originally published Sunday, July 8, 2007
Local News - gainesvilletimes.com
