The Tribune Democrat, Johnstown, PA

Jim Scofield

April 12, 2014

Jim Scofield | Fight over Affordable Care Act, and a hospital

JOHNSTOWN — The Republicans are doing all they can to prevent millions of Americans from getting health care insurance under the Affordable Care Act (Obamacare). They won’t admit it directly, but they just don’t believe all Americans deserve health care. They want us to remain the only advanced country without universal coverage.

They have voted to repeal the new health care law dozens of times. Already, 25 Republican-controlled states, including Pennsylvania, have rejected this law’s extension of Medicaid that would have covered almost 5 million Americans (500,000 in Pennsylvania) with incomes just above the poverty level.

Three dozen states refused to set up the insurance exchanges, and Texas and Missouri even impeded those helping to sign up the newly insured in the federal government exchange. Yet, with all this sabotage, the Republicans are decrying how bad the on-line problems were.

A recent Commonwealth Fund study showed that nearly half of adults ages 19 to 64 were uninsured for a period in 2012, or underinsured;  80 million reported not pursuing needed medical care or filling prescriptions because costs were too high. Prior to the new bill, many without insurance or with weak policies were being forced into bankruptcy. An American Journal of Public Health study shows 45,000 annual deaths associated with lack of health insurance.

Should we have accepted this low level of care for Americans?

Polls do show a majority  rejecting this law, especially when it’s called Obamacare, but are they informed? Provision by provision, the public  favors the law. They like the plan’s preventive care, its

banning of exclusions based on  pre-existing conditions and its ban of dropping patients who become sick, its lifetime cost limits, and its inclusion of children up to 26 years of age.  

Despite the critics’ hullabaloo about President Obama claiming that those with insurance wouldn’t be affected, the vast majority of them haven’t been. Those who were individually insured with weak plans were forced into better plans (with the above inclusions), most with more affordable rates.

All along, American insurance companies have forced their patients to change doctors and hospitals (e.g., UPMC and Highmark), but when some of the ACA plans do this, Republicans howl as if this were new.

Congressional Republicans have belatedly offered their own bill, including some of the ACA provisions, but with weak coverages and unclear funding. And Republican House Budget Chairman Paul Ryan’s plan would privatize and weaken Medicare, the government plan that covers the elderly.

Most nations see medical care as a right, a human decency. Will our country?

Unfortunately, too many Democrats have failed to defend their plan, which is one reason its benefits aren’t yet clear to the public.

And in our area, what are we to make of the sale of Conemaugh Health System and its three hospitals to the for-profit North Carolina-based Duke LifePoint? There was no public debate on this.  It was presented to the public as a fait accompli.

Why would Conemaugh’s executives give up control to outsiders? Do we want this Johnstown-area hospital to be owned and directed in North Carolina, and the profits sent there?

Duke claims that there will be no layoffs, but consolidation and layoffs go together as a business strategy.

Big hospital chains like Duke LifePoint have been busy, especially recently, buying other hospitals and physician practices.

The Washington Post noted this “wave of consolidation.” It cited a 2012 Robert Wood Johnson Foundation report that “hospital consolidation generally results in higher prices ... often exceeding

20 percent.”  

Mergers are calculated to limit competition. They claim to provide an economy of scale and to provide more services and specialists. However, specialists are not only paid more, often in high hundreds of thousands, but they may create a demand for health care that is good for business, while not necessarily for health.

American medicine needs more general practitioners, according to most observers.  

We could also worry that a big corporation like this would put pressure on the physician groups it now owns to see more patients faster, thus enhancing its bottom line for its investors.

Hospital charges for the same service vary widely. Johns Hopkins in Baltimore charged a patient $2,500 for a chemotherapy treatment, but UPMC Passavant charged almost $14,000 for the same treatment, the Pittsburgh Post-Gazette has reported.

UPMC has “a local provider monopoly,” the paper noted. Unfortunately, this typifies the incredible differences in charges in the U.S. (charges are quite lower in the single-payer systems of Europe).

Duke LifePoint’s CEO is paid more than $9 million. It’s bad enough that nonprofits like UPMC and Highmark pay many executives over $1 million dollars. For-profits like Duke LifePoint apparently exceed this pay rate.

Jim Scofield of Richland Township is a professor emeritus of English at Pitt-Johnstown.

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