GRAVETTE — As the CEO of a local health care system, including Ozarks Community Hospital in Gravette, Paul Taylor has a unique perspective on health care reform and, more specifically, the need for a public option.
Not only is Taylor a hospital CEO, an attorney and a teacher, but one of his hospitals - the Doctors Hospital of Springfield, Mo. - was reported by U.S. News andWorld Report as having the lowest outof-pocket Medicare co-pays per patient for hospital and physician services in the nation.
Ozarks Community Hospital is a small health care system with a hospital in Springfield, Mo., a hospital in Gravette and a handful of clinics. Even though OCH is a for-profit physician-owned system, approximately 80 percent of the patients are on Medicare, Medicaid or Tricare or are uninsured, according to Taylor.
When OCH re-opened the Gravette hospital in 2008, it provided critical-access care to the far northwest corner of Benton County, where getting to the nearest hospital could mean a 45 minute drive on two-lane roads or a trip in a helicopter, Taylor wrote.
Many patients who wouldn’t have survived the ambulance ride have been saved, according to Taylor.
“We think we have saved about a life a month ... I don’t know how you can put aprice tag on that,” he said.
But health care reform without a public option could put OCH in jeopardy, according to Taylor. Since OCH is a small health care system and most of its patients are either on Medicare or Medicaid or they are uninsured, OCH has little negotiating power with the big insurance companies. As a result, the insurance companies pay them substantially less than the government.
Big insurance companies and big health care systems negotiate contracts so that patients have little choice but to go to in-network doctors. Primary care physicians areforced to send patients to specialists in their own health care system, not necessarily to the best specialist for the patient.
According to Taylor, the only people who are able to “vote with their feet” and choose where to go for medical care are Medicare and Medicaid patients - the majority of OCH’s customers.
“It would appear that big insurance companies and pharmaceutical companies have won the battle (if the health care bill is passed without a public option),” he wrote.
While larger hospitals complain they won’t be able to make it on what the government pays, insurance companies actually pay OCH one third of what Medicare pays, according to Taylor. In addition, they often deny claims and take months to pay.
In a recent blog post, Taylor used Wellpoint, the owner of the Blue Cross and Blue Shield organization, as an example. The company made $3.3 billion in profits in 2007 and $2.5 billion in 2008. Wellpoint’s CEO makes $10 million a year.
“For our patient finance employees, getting a claim paid by Wellpoint in the normal course of business is the emotional equivalent of winning the lottery,” Taylor wrote.
“A public option would increase the competition, level the playing field and drive down costs,” he said.
Tax payers would not be fitting the bill for a public option. On the contrary, a public option would work like anon-profit insurance company. Premiums would be high enough to pay for the claims but not so high they created billions of dollars of excess profit.
“Health care should be able to pay for itself and health care should be supported bythe people who are using it,” Taylor said.
Another advantage of the public option is that people would be able to go to any willing provider. People would choose which doctor to use based on the quality of service, not which network they are in. Bringing back competition among health insurance companies, hospitals and doctors would create lower prices and better service, Taylor said. On the other hand, less choice equals poor quality, he explained.
If there is a mandate to buy insurance but no public option, quite naturally costs will go up, Taylor said. Without competition, big health care systems will negotiate big contracts and premiums will rise. People won’t be able to afford the premiums and the government will have to subsidize their health insurance.
Subsidizing private insurance premiums is where tax payer money would actually be used, and that money would be going straight into the pockets of big insurance companies, Taylor explained.
“The insurance lobby has done a good job of scaring the public (about the public option),” Taylor said.
Taylor has been active in sharing his perspectives about health care reform. He authored a White Paper outlining his rationale for reform and his recommendations. The White Paper can be viewed at www.OCHonline.com. More information is also available at Taylor’s health care reform blog, ochhealthcarereform.blogspot.com or on twitter at twitter.com / OzarksCH.
OCH has lowest out-of-pocket Medicare co-pays per patientBy Janelle Jessen
In July the US News and World Report published an article, titled “Nation’s 10 Least Expensive Medical Markets,” citing a 20-year study by the Dartmouth Institute for Health Policy and Clinical Practice.
The Dartmouth study named Doctor’s Hospital of Springfield, Mo., part of the Ozarks Community Hospital health care system, as having the lowest out-of-pocket Medicare co-pays per patient for hospital and physician services in the Nation.
The study asserts that lower health care costs are linked to better patient outcomes. More doctors, more tests and more procedures are not necessarily better for patient health.
Patients who had more specialists and more hospital stays often fared worse because hospital stays come with risks like infections, and multiple doctors often don’t do a good job of making sure their care doesn’t conflict, the article surmises.
To compare local hospitals and national health care systems using the Dartmouth Atlas of Health Care, visit www.dartmouthatlas. org.
News, Pages 3 on 12/09/2009