Bailing out of health care costs

Posted March 09, 2009, at 6:42 p.m.

Bailing out is the preferred method of dealing with health care costs in America. Each of us around the table — patients, employers, insurers, hospitals, etc. — save our own financial skin in part by bailing out of some piece of our responsibility for our collective costs, then passing part of our problem on to those remaining at the table. Employers bail out of their rising health insurance premium costs by passing more insurance costs on to employees, or by dropping insurance altogether. Insurers bail out of higher costs by hiking premiums. Hospitals and physicians bail out in part by raising prices or getting out of the provision of services that don’t pay, and so on.

The most recent example of this is Maine state government’s decision to bail out of its $800 million budget deficit in part by cutting Medicaid payments to hospitals and physicians.

It would be better if, when one of us bails, that party took other steps to make it easier for those left holding the health care cost bag to deal with the fallout from that bailout. For example, if Maine — or any of the many other states cutting Medicaid reimbursement to hospitals and physicians — is going to solve its financial problems in part by bailing out of its responsibility to pay appropriately for services for Maine Medicaid patients, why doesn’t it also help cut hospitals’ and physicians’ costs?

The same state government and same legislature willing to cut payments to hospitals and physicians could, for instance, have the political courage to reduce the malpractice costs those hospitals and physicians have to pay by enacting reasonable malpractice reform. Why, for example, when the Maine pre-litigation screening panel says a complaint has no merit can that still go to court? Why is there no limit on the amount someone can win for pain and suffering in a malpractice lawsuit?

Why shouldn’t the state force health insurance companies in Maine to collaborate in every way possible to lower the administrative costs hospitals and physicians have related to dealing with insurance companies? Why can’t the state look at regulatory and other costs hospitals have and help trim those costs?

Related, if we are going to get paid poorly for them, why doesn’t the state get more aggressive in reducing the number of Medicaid (and other) patients getting injured and therefore getting care? If Maine political leaders are so intent on cutting health care costs, why don’t they have the political and intestinal fortitude to ban the use of cell phones while driving, or to force 16- to 18-year-olds to wear helmets while riding motorcycles? Why should a legislator bail out of his or her responsibility to lead us in our efforts to control our health care costs by refusing to tell voters that cell phone use while driving and riding motorcycles without helmets are now unaffordable luxuries?

Our political leaders are not the only ones bailing out. When a patient walks away from his health care bills he is bailing out of his obligation to pay for his care. When a mother says she wants expensive antibiotics for her child’s pink ear despite being told the ear infection is almost certainly due to a virus that is immune to antibiotics, and does not care what the medicine costs because the child’s insurance will pay for it, she is bailing out of her responsibility to spend all of our health insurance dollars wisely. When a physician bails out of his responsibility to say no to that mother’s request because it is too much trouble and risk to do so, he has joined the bailing party.

While most constituencies around the health care table have worked hard to cut their own contributions to rising health care costs, none of us has worked hard enough. In effect, we have collectively and individually bailed out of our responsibility to do what it takes in Maine to contain health care costs. Until we find a primary solution other than the bailout approach, we all will keep using it to our individual benefit and our collective ruin. Until then, the Maine state motto “I lead” could be changed to “I bail” when it comes to health care costs.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He is also the interim CEO at Blue Hill Memorial Hospital.

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