Health care: An entitlement?

Posted 8/25/09

We respond the same way when the emergency is health-related — a quick call to 911, and we know an emergency medical technician crew will rush to our aid in an ambulance and take us to the hospital, where the emergency room staff will work to …

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Health care: An entitlement?


(Editor's note: This is the second in a series of stories taking a local look at the national health-care system dilemma.)When the unthinkable happens, and a fire starts or someone breaks into a house, it's comforting to know that help is a phone call away. Thanks to tax dollars, we can quickly dial 911, and fire crews or law-enforcement officers will be on their way.

We respond the same way when the emergency is health-related — a quick call to 911, and we know an emergency medical technician crew will rush to our aid in an ambulance and take us to the hospital, where the emergency room staff will work to save our lives.

But there, the similarity ends.

While city and county taxes, state and federal grants pay the cost to equip fire departments and to staff and equip police and sheriff's departments and justice systems, there is no such provision for medical services.

“When someone's breaking into your house, and you call 911, the expectation is that the police will respond, and we will pay for that through taxation,” said Rod Barton, executive director of Powell Valley Healthcare. “The same thing applies to the fire department, though Powell's is a volunteer department. We still pay some taxes for support of the fire department.”

“With health care, the expectation is still there, that when we call 911, there will be an ambulance to take me to the hospital, where there will be doctors and nurses to take care of me.”

But, unlike police and fire services, emergency medical services result in a large bill that the patient — or his insurance company, Medicaid or Medicare — must pay.

“As a society, we have never decided whether health care is a right, or whether it is a privilege for those people who can afford it,” Barton said. “The longer I am in health care, the more I believe it is a right.

“Health care has never been formally designated as a right of citizenship, but we act like it is ... The expectation is that health care is available to everybody, regardless of whether they have money. It's not like a car, when, if I have more money, I can buy a better car.”

While law enforcement and fire departments focus largely on crime or fire prevention, medical services that get approved for payment by insurance companies or government programs typically aim only at treating an existing condition instead of trying to prevent it.

“There are incentives out there to reduce crime,” Barton said. “If a police officer only got paid when he arrested somebody,” people would have a problem with that.

But, “there are no financial incentives to reduce illness and injury ... I do well as a hospital when we're doing lots of surgery, lots of MRIs ... I only get paid for making people well when people have problems. But I don't get paid anything for keeping people well.”

Focusing only on treating existing problems also contributes to a pending imbalance in health-care providers, he said.

The system as it is now “pays more for procedures and tests, surgeries and MRIs than it does for a doctor to sit with a patient,” Barton said. “Not surprisingly, we have a system where surgeons make a lot more than family doctors, so more of the kids coming out of medical school are going into surgery than into family medicine.”

Those issues are compounded by Medicare, Medicaid and scores of insurance companies, each of which has its own complicated set of rules.

Consequently, “there's a general unrest,” Barton said. “Physicians have told me practicing medicine is no longer as rewarding or as fun as they once saw it because of the bureaucracy of the system.”

As the battle over health care solutions continues at the national level, Barton said, nurses and doctors are as aware as the general public that something has to change.

He said it's as hard for him and other health-care professionals to wade through all the rhetoric and verbal flack that surrounds the national health-care debate.

But, he noted, “I'm told through the American Hospital Association that the bill from Senator Baucus' (D-Mont.) committee has the most likelihood of passage. He's working very hard to include Republican thought and proposals. The Senate is still working hard to make it as bipartisan as possible.”

Wyoming's senior senator Mike Enzi, R.-Wyo., is also a member of the committee working to draft a compromise health-care reform plan.

“I suggest that people watch that bill more closely,” he added.

Regardless of what direction the debate takes, “I think everyone also recognizes how complex it is,” he said.

“There is no simple fix; no easy way to do this.”

Regardless of what the solution is, “we have to get out of the entitlement mentality, to recognize that, no matter what we do, it will come with a cost. It doesn't come for free.”