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GUEST COLUMN: Doctor disappointed with Durenberger Health care industry was unfairly maligned by former U.S. senator
By Dr. JEROME D. POLAND As a former supporter of Sen. Durenberger and member of his executive finance committee in the 1980s and 90s, I am shocked and deeply hurt at Sen. Durenberger's inaccurate and distorted position on what is wrong with health care today.
I would like to offer the following observations from a provider standpoint. First of all, to give some background on Sen. Durenberger, we must remember that he is a lawyer by training, and he is currently a health care consultant who makes a great deal of money from the health care industry, a majority of which comes from the large health care corporations and the HMOs. This understandably introduces bias into Sen. Durenberger's thinking. I would also like to submit that Sen. Durenberger's thinking is pretty much the same as it was 20 years ago and certainly has not changed; he is totally out of step with the times. While he may be well intentioned, he is beating the drums with outdated rhetoric.
In one of the paragraphs on the second page, Sen. Durenberger maligned the health care profession with his comment that medical professionals are making a great deal of money from specialty clinics. He is implying that a lot of unnecessary x-rays and imaging are done simply because they own these clinics. While this may be true in isolated cases, when these cases are uncovered we have a court system to deal with these miscreants and they should be prosecuted to the fullest extent of the law, but this is no excuse to paint an entire profession with the same brush!
The senator went on to imply that a lot of the health care equipment is totally unnecessary, the MRI and CT scanners for instance, should be bought in collaborative effort. I would like the ask senator Durenberger where he has been, as this is exactly what is happening. Has anyone seen the MRI trucks that pull up to the Aitkin and Crosby hospitals and a lot of other small hospitals around the state? These are cooperatively owned by the hospitals to save money and are working very efficiently to bring care to the outstate areas. Evidently the senator does not realize that a lot of unnecessary travel, pain suffering, and even death due to lack of rural access to health care results when those of us in the smaller communities are denied this technology. We all recognize that technology is certainly increasing the cost of health care, but it is also adding to the quality of life and even saving money to the overall system by getting people back on the job faster and back into productive lives faster.
Sen. Durenberger points out that there are five specialized heart centers in the Twin Cities an that there are 21 CT scanners within a 2.1 mile radius of Fairview Southdale Hospital without making any mention of whether or not these are being efficiently utilized and whether or not they may indeed be necessary due to the high population density in that area. Sen. Durenberger, 20 years ago you were talking about injecting competition into the health care field. Isn't this exactly the type of competition that you had planned at that time, and what has made you change your mind now?
The senator then further impugns the medical establishment by stating that according to recent statistics between 44,000 and 98,000 lives are lost each year due to medical mistakes. This study is a poorly designed study and it was anecdotal study at that. As you can see from the numbers, it has a 120 percent error margin.
One of the totally overlooked items and the biggest item in terms of the cost of health care that Sen. Durenberger omitted to mention (as your recall in my opening paragraph I stated the fact that he was trained as a lawyer) is the cost of litigation. We have all heard about the increase in malpractice insurance premium. I, myself, have suffered a malpractice premium increase during my 30 years of practice that is 600 times as high as it was in 1975. This, while it is enormous, is not anywhere near as great as the contribution to health care cost necessitated by unnecessary referral and testing done by all doctors simply to avoid the possibility of being sued.
As a referral specialist, I get patients that are sent to me all the time by primary doctors in the area that have a great deal of marginally necessary expensive testing, such as MRIs and CT scans, performed before they are ever sent to me. This is done in fear of the primary care practitioner being sued for omitting some of these tests, when a simple examination by a specialist, an ophthalmologist in this case, could have provided an inexpensive answer to the patient's problem. Doctors are simply afraid to make a clinical judgment in this day and age because of the fear of being sued. President Bush, in a speech on Jan. 5, 2005, in Madison, Illinois, revealed that as much as $100 billion a year is wasted on defensive medicine. It is not because the doctors are profiting from it, they are simply afraid of being sued. This is something that society simply has to come to grips with if we are to truly eliminate unnecessary health care and control costs. I would also like to add that government mandated forms and paperwork are a significant contribution to unnecessary health care costs.
We, as Medicare providers, are continually receiving changes in the way that we must report and bill for Medicare services, every time we need a software change it costs between $10,000 and $25,000 for our small clinic to upgrade the system. Sometimes these changes occur two to three times a year. When you multiply this out across all the clinics and hospitals across the country, this amounts to an enormous portion of the health care budget. This expense is increasing rather than decreasing and it does not seem to matter whether the Republicans or Democrats are in office, they all seem to be racing to add to this horrendous burden.
One of the totally overlooked facets of health care that Sen. Durenberger conveniently omitted, and something that I have taken him to task for in the past, is that health care is first and foremost a business. It brings a necessary service to the smaller communities, a service to which we feel we are entitled. In fact, if you look at the statistics, the rural health care area is a shining example of what can be done with collaboration and with cost effectiveness in delivering health care. If we could only get the government, the insurance companies, and the lawyers off our back, it would even be more cost effective. The largest employer in this area is not recreation, but it is health care. The small town of Crosby, with a population of 2,200 people has 750 people working in the area of health care. Aitkin, similarly, with 1,900 people has over 500 people employed in health care. Brainerd, with 13,000 people has over 3,000 people employed in the heath care sector.
Senator, these are stable year-round jobs. This money comes right back to the community where it originated. This is not to say that it justifies excessive spending, but as I pointed out earlier, the excessive costs are due in large part to lawsuits and government.
Another area which the senator has totally omitted discussing is the enormous amount of revenue that is being drained from the health care sector by the CEOs and the management of the insurance companies. When one looks at the $93 million dollar bonus that William McGuire, the president of United Healthcare, received two years ago, this would more than pay for all the 21 CT scanners that Sen. Durenberger implied above as being superfluous in the Southdale area. Why is it OK for an executive to make a $93 million bonus plus his multi-million-dollar salary, when it is not OK for a nurse, health care worker, lab technician, or physician in a small town to make a living wage? Is this really the role model that we want? Something must be done about the excessive exorbitant executive compensation in the health care field.
Another very large factor in the escalation of health care costs is the aging of baby boomers. As these people reach their 50s and 60s they use ever increasing amounts of the health care dollar. Apart from euthanizing large numbers of these people the only thing we can do to reduce this impact is to vigorously promote healthier life styles.
You mentioned cost shifting in your speech. The cost shifting that hospitals do is because of Medicare mandated payments that are below the cost of providing care. In order to stay in business it is necessary for the hospitals to shift costs on to non-Medicare patients. This is one way our elected members of Congress have caused Medicare to shift cost to the private sector: a hidden tax!
I would suggest that the good senator go back to his books and listen to the people in the hinterland and cut his ties to the HMOs and corporate medicine to really objectively help us with our health care problems. So far, all you have done is criticize and malign the sector of the population that has been your largest support base.
Sen. Durenberger, I am extremely disappointed in you.
JEROME D. POLAND, M.D., is the co-founder and owner of Crosby Eye Clinic. He has practiced ophthalmology for more than 30 years.
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