Health Care Forum addresses insurance and reform issues
August 18, 2005
By Janet Hefler
Michael Dukakis, former governor of Massachusetts, chats with audience members at a health-care forum last Sunday where he participated as a panelist.
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A forum on national health care policy revealed sharp divisions among medical providers, policy makers, and the public on the subjects of system reforms and universal health insurance.
Held on Sunday afternoon on the grounds of the Martha’s Community Services, the sixth and final health forum in a series featured a “conversation in the round” where the audience encircled the seven panelists.
Dr. Charles Silberstein, a Vineyard psychiatrist and founder of the Foundation for Island Health, moderated the event. The panelists included Michael Dukakis, the former governor of Massachusetts, Michael Goldfein, MD, Timothy Guiney, MD, Chip Joffe-Halpern, Judith Kurland, Richard McGreal, and Paddy Worlock Moore.
Dr. Silberstein launched the discussion by asking, “How many of you think health care is a basic human right?” Every one of the 50 or more in the audience raised a hand, including the panelists.
However, providing health care to everyone is not just a question of spending more money on it, the panelists agreed. At present, the U.S. spends some $2 trillion a year on healthcare, said Michael Dukakis, the former governor of Massachusetts and an advocate for healthcare reform. This expenditure surpasses that of all other countries, Dr. Silberstein pointed out, yet the U.S. is ranked 21st in the world in terms of overall healthcare quality.
“If you come for a visit to the emergency department at Mass General, you’ll find we can spend money faster than the Pentagon,” quipped Dr. Guiney, a leading cardiologist at Massachusetts General Hospital and a Martha’s Vineyard Hospital board trustee.
An issue of disparity also exists, noted Ms. Kurland, the former regional director for the federal Department of Health and Human Services (HHS). “We do not have an overarching system of healthcare, and we also do not have a public health approach,” noted Ms. Kurland.
Such an approach, she explained, would focus on preventative of disease first, rather than its treatment. The responsibility for creating such a system would fall to both the government and the public, Ms. Kurland said.
Mr. McGreal, the current regional associate HHS administrator for Medicaid and Children’s Health, noted that the current administration is looking at Medicare and Medicaid “…not as just a payer but a player in the public health arena.”
Mr. McGreal’s agency is examining the issues of health care quality and pay-for-performance, which he defined as offering monetary rewards to doctors who do a better job of keeping patients healthy.
“I have to be very cynical,” commented Dr. Goldfein, a longtime Island pediatrician and the current hospital chief of staff. “My concern is it is a ploy by the insurance industry to pay doctors less - to reward those who order less tests and prescribe more generic medications.”
Regardless of what kind of health care is offered, Mr. Dukakis said, “How do we make sure every single American has this right that 100 percent of us thinks we have?”
He questioned why 30 percent of Massachusetts businesses do not provide health insurance to their employees.
“That means the others are footing the bill. Why is the business community so quiet on this subject?” Mr. Dukakis asked. He advocates shifting the health care burden from the state to employers.
Cathy Brennan, a nurse and former director of the Martha’s Vineyard Hospice, disputed Mr. Dukakis’ position. “I’m shocked you think health care should fall on employers. If you are out of work, you are out of insurance,” she pointed out. “On Martha’s Vineyard, we have small businesses. It can cost $6,000 a year for an individual health insurance plan and $10,000 to $12,000 for family plans. Small employers cannot afford this.”
Mr. Dukakis pointed to Germany and Japan as models for successful employee-based health care, and suggested possibly exempting small businesses. The discussion also turned to the issue of social responsibility versus fiscal responsibility in providing health care to everyone. As Dr. Barry Stein, an audience member, pointed out, “Why should costs be undertaken by businesses when they’re only covering part of healthcare costs? It needs to be covered by society as a whole.”
Putting the issue into practical terms, Ms. Moore, president of the Foundation for Island Health, asked, “Is it a social responsibility, and are we willing to see our taxes go up because of it?” When polled, the majority of audience members raised their hands in support.
Although the uninsured pay 35 percent of their healthcare costs, Ms. Kurland said, $1,200 of every family insurance packet goes to pay for people who are not covered. “Somebody is paying for it,” she pointed out. “It affects society as a whole.”
Speaking in favor of expanding its coverage, Mr. Dukakis noted that “Medicare works in Martha’s Vineyard and it works in Harlem. We have to have a national solution, and we do have one, Medicare. It works pretty well.”
Dr. Guiney agreed: “One of the tragic mistakes of the Clinton administration was to put together a Rube Goldberg-type plan instead of doing a Medicare-type plan.”
In reforming health care, Mr. Dukakis argued that policy could not be divorced from politics.
“The solutions are easy,” he said. “The question is why we can’t get the politics in line to get the job done. We need to summon up political will – we have to have a President who wants to do it.”
Concerning legislation at the state level, Mr. Joffe-Halpern, the executive director of Edu-Health Care and current president of the board of directors for Health Care for All in Boston, advised everyone to pay close attention to differing Massachusetts universal healthcare legislation proposed by Governor Mitt Romney, Senator Robert Travaglini, and Senator Richard Moore.
At the local level, Cynthia Mitchell, executive director of Island Health, Inc. noted that the island’s health plan is “down to the last piece,” approval of a waiver amendment by Mr. McGreal’s agency, the Center for Medicare and Medicaid Services.
Mr. McGreal promised, “I am going to help you, and I will help my region look to these options to expand healthcare.”
The six health forums will be available in DVD format at the Island’s libraries in about a month.
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