Your Bangor community health care organizations need to let you and our legislators know that we are deeply concerned about the negative impact of the supplemental budget proposed by Gov. Paul LePage.
This budget will lead to all of us paying more for health insurance, hundreds in our area losing their jobs, and most important, 14,000 losing health coverage. The hundreds who will lose their jobs in the Bangor area are real people — they are our friends and neighbors, as are the thousands who no longer can obtain health care with their physician, dentist or mental health provider. They are someone’s mother, father, sister, brother, daughter, son or friend.
This isn’t how we do things in Maine.
Foreseeable direct cuts to Maine hospitals and health care organizations total more than $50 million. Indirect impacts will increase costs millions more. The changes, should they be adopted as proposed, will hurt our capacity to treat all Maine residents regardless of ability to pay. The proposed reductions could result in service cuts, cost shifts and layoffs severely affecting hundreds of thousands of people across Maine.
The governor’s budget will cut about 14,000 people in our region from MaineCare health coverage. These people have no money to buy health insurance. They will be forced to get their health care in hospital emergency departments. Community health centers, community and public health organizations, area homeless shelters, law enforcement, municipalities and prisons all will absorb higher costs.
Emergency departments will be overcome as Mainers in need of basic health care services lose their doctor, dentist or mental health provider. Emergency departments are a much more expensive and far less effective way to provide care. Our Bangor area hospitals cannot absorb these costs — they will be shifted to private insurance and thus to businesses and to all of us as employees.
There is no free lunch in health care — we all need it and it all needs to be paid for. Our choice is: do we pay less by keeping people healthier or do we let people get sicker and obtain care in very expensive emergency departments or in hospital beds?
Here’s just one example of how the proposed budget actually will cost taxpayers more, not less. If a MaineCare patient goes to Penobscot Community Health Care’s Dental Center, MaineCare pays $140 for the visit and the dental problem is fixed. If that same MaineCare patient ends up in an emergency department, MaineCare (us taxpayers) will pay $500-$700 and the problem cannot be fixed because the emergency departments do not have dentists.
The cost and problem likely will be compounded if the patient is given drugs to deal with the pain. The patient will have to go again and again to the emergency department to get painkillers, costing taxpayers $500-$700 every time instead of paying just $140 to fix the problem. Why waste all that taxpayer money?
Proposed changes will threaten the financial viability of health care institutions that care for Maine people. The growing costs of providing even more charity care will further burden already thin operating margins for Maine hospitals and health care organizations; organizations still awaiting nearly $400 million in MaineCare payments.
We urge policymakers to analyze what the impact of 65,000 newly uninsured Mainers really means to our health care infrastructure and total health care costs, and only then make truly informed decisions regarding the MaineCare program.
Our Bangor health care organizations are all working to improve health care, keep people healthier and keep them out of emergency departments and hospitals when there are other avenues for help, while reducing costs. This is how to save taxpayers’ money, not by cutting people off MaineCare or cutting services.
Maine poet Henry Wadsworth Longfellow wrote, “Give what you have. To someone, it may be better than you dare to think.” Maine health care providers know that what we have and what we give is critical to Maine people: quality, accessible health care for every Maine person who needs it, regardless of his or her ability to pay. We cannot provide this alone, however. Our patients, our employees and our capacity to give what we have will bear too heavy a burden should the changes as proposed are adopted.
Dale Hamilton is executive director of Community Health and Counseling Services, Mary Prybylo is president and CEO of St. Joseph Healthcare/St. Joseph Hospital and Kenneth Schmidt is CEO of Penobscot Community Health Care. All three organizations are based in Bangor.
No need to worry. Republican leaders and conservative media have been busily at work convincing everybody that–
1) Nobody is actually poor; they’re just pretending or frauds or something
2) People are poor, but it’s their own fault
3) If you have a job, you can’t possibly lose it (and become poor). And if you did, you’d simply create a job for yourself and rapidly become a millionaire.
4) If you’re currently healthy it means you’re a good person and can’t possibly become ill or have a serious accident (also, there’s no such thing as an “accident”)
5) Therefore, it’s a great idea to destroy any services that might help desperate people because they don’t exist, their circumstances are their own fault, and YOU could never become one of them.
You forgot #6: It’s OK to earn excessive profits or incomes in health-care because that is the only way to run a national health-care system.
I’ve read that the CEO of one for-profit insurance company has a salary around $24 million per year. I think some get even higher. Salaries like that depend on a LOT of people’s legitimate claims getting denied, and the insurers denying policies to people with pre-existing conditions.
Sounds like you did some serious research prior to posting this.
December 2009: Sen. Orrin Hatch (R-Utah) describes the previous eight years as an era in which Republicans believed “it was standard practice not to pay for things.”
2009 – 2010: Congressional Democrats unveil several domestic policy initiatives — health care reform, cap and trade, DREAM Act — which would lower the deficit. GOP opposes all of them.
September 2010: In Obama’s first fiscal year, the deficit shrinks by $122 billion. Republicans again condemn Obama’s fiscal irresponsibility.
October 2010: S&P endorses the nation’s AAA rating with a stable outlook, saying the United States looks to be in solid fiscal shape for the foreseeable future.
November 2010: Republicans win a U.S. House majority, citing the need for fiscal responsibility.
December 2010: Congressional Republicans demand extension of Bush tax cuts, refuse to consider paying for them, demand that the costs be added to the national debt.
March 2011: Congressional Republicans declare intention to hold full faith and credit of the United States hostage — a move without precedent in American history — until massive debt-reduction plan is approved.
July 2011: Obama offers Republicans a $4 trillion debt-reduction deal. GOP refuses.
August 2011: S&P downgrades U.S. debt, citing GOP refusal to consider new revenues. Republicans rejoice and blame Obama for fiscal irresponsibility.
October 2011: Working through the so-called super-committee, congressional Democrats offer Republicans several plans to reduce the debt by trillions of dollars. GOP officials not only refuse, but counter with alternatives that make the debt worse.
November 2011: The national debt tops $15 trillion. Republicans, hoping Americans ignore the previous 30 years, blame Democrats.
You are a prime example of the problem we’re facing right now. The Republican didn’t cause this problem alone. Even though the deficit shrank by $122 billion, the federal government still spent $1.294 trillion more than it collected in the fiscal year that ended Sept. 30, 2010. It was both parties that caused this and not the republicans alone. Since we only have 2 factors that will reduce the deficit, Revenue and Spending, it seems like a simple answer but this is where the differences lay. The Republican want to address the Spending and the Dem’s want to focus on taxing the rich to increase Revenues. Below are three quotes from Walter Williams and a prime example of why we need to focus on spending. We’ll also have to increase revenues but you can not demand that from the people of this country without addressing the wasteful spending and addressing all the policies that handcuff our companies and businesses from functioning effectively.
“If Congress imposed a 100 percent
tax, taking all earnings above $250,000 per year, it would yield the
princely sum of $1.4 trillion. That would keep the government running
for 141 days””Taking corporate profits would
keep the government running for another 40 days, but that along with
confiscating all income above $250,000 would only get us to the end of
June”.”America has 400 billionaires with
a combined net worth of $1.3 trillion. Congress could confiscate their
stocks and bonds, and force them to sell their businesses, yachts,
airplanes, mansions and jewelry. The problem is that after fleecing the
rich of their income and net worth, and the Fortune 500 corporations of
their profits, it would only get us to mid-August”. Here’s the whole article. http://jewishworldreview
You seem to be ignoring the part about how the deficit always GROWS under Republican presidents. They only pretend to care about the deficit–Cheney himself has said deficits don’t matter. They’re using the “Eeek! A deficit!” tactic to destroy everything ordinary people need– decent wages, unemployment insurance, Medicaid, Medicare, Social Security, laws restricting pollution.
http://krugman.blogs.nytimes.com/2011/06/24/phony-deficit-hawks/
“Federal tax receipts as a percentage of GDP are near a historic low… the GOP never cared about the deficit — not a bit. It has always been nothing but a club with which to beat down opposition to an ideological goal, namely the dissolution of the welfare state. They’re not interested, at all, in a genuine deficit-reduction deal if it does not serve that goal.”
Both parties are at fault and for you to only blame the Republicans is the problem we have on boths sides of the aisle. The Dems had control of the Presidency, the house and senate from 2008 through 2010 and what did they do to reign in spending. Nothing. They actually doubled down on the spending and they continue to do so to this day. It’s time for both sides to come together and focus on what is best for this country. The number one goal should be to increase the tax receipts by getting people back to work as fast as possible. That’s not going to happen in this current business environment until things improve. With all the regulations we have, high energy costs and future taxes businesses face, it’s no wonder they’re not hiring.
Who’s complaining about “regulations”? The bankers who brought us to the brink of Depression II. The huge manufacturers who increase their profits by polluting the air, water, and soil. Not a whole lot of those in Maine, even if we wanted to kowtow to them. Small businesses, on the other hand, by and large aren’t complaining.
http://tinyurl.com/3zrjhvw: “McClatchy reached out to owners of small businesses, many of them mom-and-pop operations, to find out whether they indeed were being choked by regulation, whether uncertainty over taxes affected their hiring plans and whether the health care overhaul was helping or hurting their business. Their response was surprising.
“None of the business owners complained about regulation in their particular industries, and most seemed to welcome it. Some pointed to the lack of regulation in mortgage lending as a principal cause of the financial crisis that brought about the Great Recession of 2007-09 and its grim aftermath.”Some small business pointed to the cost of health insurance as holding them back. Others cited a simple lack of customers (consistent with an economic slump caused by lack of demand). “I think the business climate is so shaky that I would not want to undergo any expansion or outlay capital,” said Andy Weingarten, who owns Almar Auto Repair in Charlotte, North Carolina.”Several respondents actually pointed to the 2009 Recovery Act (i.e. the stimulus), which was almost unanimously opposed by Republicans, as helping to boost their businesses. “It allowed those folks to spend and have money and pay for the essentials,” said Rip Daniels, who owns four businesses.”
“Some small business pointed to the cost of health insurance as holding them back. Others cited a simple lack of customers (consistent with an economic slump caused by lack of demand). “I think the business climate is so shaky that I would not want to undergo any expansion or outlay capital,” said Andy Weingarten, who owns Almar Auto Repair in Charlotte, North Carolina.
“Several respondents actually pointed to the 2009 Recovery Act (i.e. the stimulus), which was almost unanimously opposed by Republicans, as helping to boost their businesses. “It allowed those folks to spend and have money and pay for the essentials,” said Rip Daniels, who owns four businesses.”
Here is Maine’s data for 2005-2009 alone from http://www.usgovernmentrevenue.com. In 2005-total revenue $8.7 billion, spending
$10.2 billion; 2006- total revenue $8.8 billion, spending $10.7 billion;
2007- total revenue $9.96 billion, spending $10.85 billion; 2008- total revenue $8.3
billion, spending $11.2 billion; 2009- total revenue $6.32 billion, spending
$11.84 billion. We are a bankrupted state and a bankrupt country and whether we like it or not, we’re going to see significant cuts across the board that will and should affect everyone. For decades now, politicians have been making false and empty promises and we are now starting to see the results of those actions. We had a chance to improve healthcare 3 years ago and all they gave us was Obamacare. Government has never been able to run an efficient government program and Obamacare won’t be any different.
While I’m no fan of the governement getting into the health care arena (beyond reasonable regulation to keep money-pursuing wolves at bay) I am getting entirely fed up with blaming Obama/Bush/Clinton et.al for the runaway train that’s finally hit the wall after at least 25 years (and, IMHO, starting in earnest when HMO’s stuck their money-grubbing paws in the insurance till).
While reasonable preventative medicine measures are indeed prudent, my insurance company does NOT have to hire an RN Case Manager to call me to make sure my ‘questions are answered” during my pregnancy seeing as I’m perfectly capable of obtaining the information myself for little to no cost to my insurance premium to pay her salary.
Ditto for when pharmaceutical corporations were eventually allowed to convince us via the evening news that we were going to die without the latest pill or other magic potion to make our lifes discomfort-free always. “Got this? Got that? Ask your doctor if I Can’t Cope can help you today!” Log onto Astro-nomical Send-yer-Cash Inc. now and get a $15 dollar off coupon for a trial. I’d like to know how much they infuse into campaign coffers.
Health care has been broken for a very long time.
We sent a Troglodyte bully with an ax to Augusta. What did we expect? Good governance?
The mistake in this essay is the assumption that the Penguin administration will respond to logical, intelligent, rational statements and do the right thing. What actually needs to happen is that the majority of the people in Maine who did not vote for Penguin need to stand together to protect our State from the incompetence that currently controls it.
Here is a more realistic assesment of costs for the hypothetical Maine Care recipient: The patient has a toothache one day and decides that night that he or she needs immediate attention as the ibuprofen is not working. There is no charge to access the ER on Maine Care so the patient goes to the ER with the complaint of a toothache. We pay 5 to 7 hundred for the ER visit, plus the cost of prescription painkillers for the patient. Then the patient calls the dental center and schedules an appointment and gets the problem fixed, hopefully.
Can cuts be made to MaineCare without sending people onto the streets to die? Certainly. So let’s stop all the scare tactics and contribute meaningfully to how we are going to go about this. NH and other states have tighter eligibility requirements for Medicaid and their people are not dying in the streets, be they young or old. So cut the hyperbole nonsense. LePage is no monster, just a man elected to do a job putting our fiscal house in order to make it sustainable for the future.
You’re creating what’s called a “straw man”–an example you’ve created out of thin air with no basis in fact. You demolish the straw man and declare victory. You offer no proof that MaineCare recipients visit the ER for very minor conditions. You simply assume they do, and on that basis you hope to end MaineCare for thousands of people.
Why would I create a straw man when it’s not even Halloween? I wouldn’t post something that I knew nothing about. I am not absolutely certain that I have seen an ER visit for a toothache, but I have seen Maine Care recipients go to the ER with a sore throat, because their child is constipated, with back pain–these three come to mind. It was suggested to them that they schedule a visit with their physician to address the problem, but they insisted they didn’t want to wait. The usual routine was hours-long waits in ER, followed by a nebulous diagnosis, a prescription for a painkiller or antibiotic, and the recommendation that the person follow up with their primary physician. There was not one admission to the hospital for a serious, emergency condition.
I hope to reform government aid programs so that people who access them will use their resources as carefully and respectfully as the average, middle class taxpayer uses theirs. I have health insurance, but I have a co-payment for ER use that discourages me using it for primary care. I have a deductible that must be met. I pay premiums every week. Every person who accesses Maine Care needs to understand that it may be “free” to them, but it is not free.
How much depth of detail did you gather about these folks? Did you review their medical charts?
We took one of our own kids to the ER years ago,when she was three (we’ve always had insurance). Gut pain kept her up & screaming for 3 hours straight. By the time we got there she was quiet, but we figured probably just exhausted. We grimly sat through the long wait. She had an x-ray, which couldn’t have been done in a doctor’s office. It’s been 30 years–I no longer recall the result. I know they gave her a painkiller. Most people wouldn’t sit through several hours in a waiting room unless they were in pretty dire straits or didn’t have a PCP to go to.
As for toothaches, perhaps you’ve never had an infected/abscessed tooth. It’s not only painful beyond what over-the-counter medicine can handle, but it can signal an infection that’s on the verge of being systemic. A systemic infection can cause brain damage or death.
I agree that resources should be used wisely. I disagree with second-guessing the severity and diagnoses of people you happen to see in an ER. Or perhaps you’re a medical professional who has skimmed people’s charts out of curiosity? A HIPAA violation…
I’m concerned that too many people who have no insurance (or whose insurance policies have sky-high co-pays) don’t get preventive or early care. Then when they finally get to the ER it’s for something huge, expensive, and perhaps no longer curable.
Hahaha. I like how the subtle character assassination comes in…No I have not violated any law to obtain this information and it is not merely because I witnessed someone in an ER and made assumptions. These experiences have been made as part of my time working in social services. Actually, yes, I was aware of health history and more. I am not even condemning the individuals who went to the ER. For some reason, they felt they had to go. I do condemn a system that allows young adults to come of age with no sense of managing money and coping with life situations. I do condemn a social service net that does not push clients to increased self-sufficiency in a more expeditious manner.
Don’t believe for a moment that cuts cannot be made. They can. And it will not result in granny dying out in the cold streets of Bangor or children starving in back alleyways.
One thing you are right on about is that I have never had an abcessed tooth–but I have read about them in a Dostoevsky novel. Ouch.
http://muskie.usm.maine.edu/Publications/PHHP/Maine-Emergency-Department-Use.pdf
Pay particular attention to pages beginning at around 80
(ED visits Resulting In Inpatient Hospitalizations vs. Outpatient ED Visits.
Interesting study. Thanks for posting the link.
You’re welcome. I hope that at some point in time, we can all discuss possible solutions to this incredibly complicated problem (with many different causes) without screaming misinformation all the time like society seems to do now.
Here’s hoping :)
Looks like most visits to the ER don’t result in hospitalization, whether they are made by people on Mainecare, Medicare, or commercial insurance. For example, 1580 insured and 1899 uninsured people with acute pharyngitis went to the ER and were not hospitalized.
Complications can include blockage of the airway in severe cases. Medline says, “Seek immediate medical care if you have a sore throat and trouble breathing.” Neither of us knows what proportion of people with this condition were having trouble breathing.
I’d like to see a kind of step-down ER available for the less urgent cases. More of a 24-hour clinic. These exist in some areas.
Not very many people are hospitalized now (or for that long a stay) generally speaking; however, the point to be made is that the ER (in many cases) is being used in place of primary care for a myriad of reasons (included in those reasons are things such as ‘convenience’). I can tell you (as a person who has long-standing and varying experience in health care employment – 23 years going now) that when most people with private insurance which requires them to pay either a co-pay, or requires that a sizable chunk of the ER fee goes to co-payment are sick, they think twice about going to the ER with that headache, or muscle spasm – even something which is a true emergency (such as an allergic reaction or trouble breathing).
MaineCare will often require some sort of co-pay (even as little as a couple of bucks) for an office visit depending on what extent the person is covered (a little known fact in the ‘talking point’ ranters’ circle) but nonetheless, when someone shows up in an ER (which, btw, is federally mandated to see anyone regardless of their ability to pay) then they’ll go there if they have no money. Plain and simple fact there. There are also those who are scraped up off the street on a regular basis and brought in for detox, and I assure you that they don’t care who pays their bill. That’s an entirely different subject and too complicated (and sadly – inflammatory to those who just want to yell) to go into here.
If the state boots the unemployed/underemployed/disabled demographic off MaineCare, then the hospitals stand to lose what little reimbursement they get now (keep in mind the state still owes many providers a LOT of money from services already rendered from years ago).
Hospitals pay their bills by negotiating ‘confidential contracts’ with private insurers to pay those bills while the state farts around trying to figure out how to weasel out of them because they lack the funds to do so. It’s a very complicated push/pull system that few ‘talking pointers’ have any clue that goes on.
What the article states is indeed a fact – an ER visit can cost 3 times what the average office visit costs. The statement that it’s going to cost the taxpayer more is true, but if the patient is kicked off mainecare then the fact of the matter is that it will cost the few of us left with private insurance 3 times more to cover the expenses of the uninsured. I can almost bet money that we will see smaller hospitals (who haven’t aligned themselves under the shelter of larger Healthcare Foundations that is) shut down.
One thing I also found quite interesting in the study was that another factor contributing to ER use is the providers on call telling the patient to go to the ER. That little nugget is called “Cover Your Butt” and this practice ought to be dealt with as well IMO. That boils down to lawsuits for not correctly diagnoses.
Walk-In Care has alleviated a lot of congestion in the ERs, but as more people lose their jobs and healthcare coverage, the ERs will be used regardless.
Just as an aside to the coversation, as much as I hear people talk about the ‘abusers’ of the system (and yes, of course there are those who do) I still want to see a comprehensive study of people who actually WORK and are covered under MaineCare because their fortune 500 service sector corporations don’t even offer the ‘in’ to a reasonable insurance package (Maine pre-existing condition laws aside). To add insult to injury, they ship most of their profits to their HQ stores in states where corporate welfare is happily doled out because it provides ‘jobs.’
Excellent points. Happy New Year!
Actually, Ms Davies, I can offer a little proof. Recently, I visited a local hospital’s ER with my granddaughter as advised by her pediatrician. The child did not want to be there. In the bed next to her, a person was greeted by the medical person and asked what the problem was. The person stated that she had a toothache and since MaineCare did not pay for dental care (the words of this person) she decided to come into the ER. The medical person checked the situation, then went and made a phone call to Penquis Dental and arranged for the pulling of the tooth the next day. This medical person had the knowledge to pull that tooth as it was hanging by a thread. However, a whole bunch of agencies and boards would have pulled him up on the carpet for practising dentistry without a license. But, the tooth would have been gone, therefore the pain as well and the cost for that ER visit would at least not have been in vain. Oh, and by the way, my grandchild said, “I can pull it for her! I pull mine.”
My cousin lives in NH. she has MS. she called her dad in tears 1 day as there was a medication she needed that her insurance wouldn’t cover. I don’t know if she is on Medicaid but i am assuming there are some in ME who can qualify for Medicaid and get the meds they need & others in NH who can’t qualify as ME is more liberal. Thank goodness some people are fortunate to have families who can and will help them to get proper medical care.
Each state is different in what it requires for coverage. For instance, when I had a homebirth with a midwife in NH, state law mandated that insurance cover that. In Maine, my insurance did not cover a home birth with a midwife.
…….”Community Health and Counseling Services, St. Joseph Healthcare/St. Joseph Hospital, Penobscot Community Health Care”…….
Without even looking, I am certain that these “healthcare providers” are taking in millions of dollars a year of the taxpayers money. So one could not exactly say the opinions stated in this article are “unbiased”.
I suspect very strongly that they are looking more at their own “financial interest” than for any particular person needing care.
‘taking in millions of dollars’ ?? Hardly.
http://bangor-launch.newspackstaging.com/2011/01/12/health/with-supplemental-budget-lepage-seeks-to-pay-hospital-mainecare-dept/
Maybe “Landslide” LePage can convince Marden’s to open up a salvage medical department.
Sigh. Lunchbucket… lunchbucket….
I wouldn’t have a lot of trouble with the government’s providing universal healthcare IF it were modelled on the Army’s, which provides its medical personnel with an adaquate but not lavish income. But try to implement that and I’ll bet that many health professionals who think state support is just fine – when they set the fees – would suddenly discover what an offence to freedom government healthcare was.
Absolutely incredibe. The Rs and their fellow travelers obviously can’t do a meaningful cost/benefit analysis. One wonders if they can even balance a checkbook.