Round table on the cost of health:  Wanting a healthier system


By Allan Drury and Julie Moran Alterio
The Journal News
A physician told of how he once saved a woman's life by amputating her toe in an emergency surgery only to have an insurer say it would not cover the procedure because he did not get authorization in advance.

A soon-to-be senior citizen from Pleasantville, Anita Reilly, said she is dreading having to research the complex and intimidating question of what insurance will be best for her to supplement Medicare once she turns 65
in June.

And Dina Flihan, a nursing student at Westchester Community College in Valhalla, spoke of how friends and family try to discourage her from becoming a midwife because she'd have insurance costs. She'd be better off as a hospital floor nurse, they tell her.

Society's frustrations with a health care system that forces doctors to justify medical decisions to non-medical experts in order to get paid, leaves millions without coverage, and is a crushing cost for individuals and small businesses were on display at a panel discussion last month at the offices of The Journal News in Harrison.

The newspaper invited the 12 panelists to provide perspectives on what works in the system, what doesn't work and how the flaws can be fixed.

Consensus emerged on several points. Panelists agreed morality requires a nation to see that everyone has access to basic health care and that a single-payer system is probably the way to go.

Georganne Chapin, the president and chief executive of Hudson Health Plan, a nonprofit managed care organization based in Tarrytown, said wealthy people will always have access to more services, but nobody should be shut out.

She drew an analogy to the way the country treats education. Many parents who can afford private schools or tutors choose those services for their children, but the public school system is there for every child, no matter how modest the family's means may be.

Harriet R. Feldman, dean and professor in the Lienhard School of Nursing at Pace University, reminded the panel that former President Clinton pushed for universal coverage during his first term in office. It failed, but a number of states have gone to single-payer systems, she said.

The nation needs another conversation about universal care, she said.  "It's time for us to bite that bullet, I think, and get talking very seriously about universal health coverage," she said. "I think it's the only way that our society will emerge in some state of reasonable health."

Panelists in the 90-minute session also agreed society has to do a better job of educating kids about healthy eating and exercise.

"You're not a patriot if you don't watch the Super Bowl with a big bowl of chips in front of you," Chapin said, referring to the marketing power of companies that sell junk food.

Gerrie Colombraro, assistant dean at the Lienhard School, said her school has a federal grant to teach children good eating habits. It is not unusual, she said, to encounter middle school children who have never eaten a salad.

She said those children need to confront the questions: "What do you want to be like when you're 15? What do you want to be like when you're 30?"

But Jeffrey Anderson, a paramedic with Westchester EMS and the Tarrytown Volunteer Ambulance Corps, emergency medical services provider from Tarrytown, pointed out that it can be expensive, especially for low-income families, to dedicate themselves to healthy eating.

Much of the conversation focused on the struggle that pits physicians and patients against insurers.

Dr. Michael Giannone, a podiatrist from Mount Kisco, said 40 percent of consumers' health care dollars go toward paying the administrative costs of insurance companies. The companies employ armies of people to delay payments and find ways to avoid making payments to physicians, he said.

He said he was able to persuade the insurer to cover the surgery on the woman whose toe he amputated only by promising the company he would never amputate the toe again. It would obviously have been impossible for him to amputate the same toe again, but going through the formality of making the promise seemed to satisfy some bureaucratic insurance company requirement.

He said he employs two people in his office to deal with insurance companies. Getting short shrift on payments forces a doctor to take on a heavier patient load in order to bring in the income needed to run the office, he said. Doctors who are rushed can make mistakes, he said.

Giannone said he believes that patients should be advocates for their doctors. He recalled performing a $5,200 surgery on a woman and receiving only $800 from the insurer. The patient thought the insurance company was being unfair to her doctor and called to complain, he said. The insurer responded by paying an additional $1,500, he said.

He called Medicare the only insurance system that works.

But amid all the problems, there is progress in some areas.

Marianne Defazio, director of global health benefits for IBM Corp. in Armonk, said she thinks that employers have stepped up with programs that encourage good health habits. IBM, for instance, pays cash to workers who stop smoking, she said.

"Our non-smoking rate improved by 10 percent," she said. "We're more than 90 percent smoke free at IBM."

The company also rewards workers for exercising, she said.

For smaller businesses, the costs can be crushing. Mark Pasdon, a founding partner at Oxygen Electronics in White Plains, said companies like his do not have the resources to offer wellness programs. "We have to shoulder the burden," he said.

There have been additional stresses placed on the system locally, said Joe Bilotto, the deputy chief of Harrison Emergency Medical Service and a 2006 recipient of a paramedic of the year award from the Westchester Regional EMS Council.

Since the closing of United Hospital in Port Chester, many patients want to go to Greenwich Hospital in Greenwich, Conn., but his agency's motor vehicle insurance covers accidents for transport only to hospitals in New York. If there's an accident, the insurance issues become complicated, he said.

Hospital closings have made it harder on patients, he said.

"We lost St. Agnes Hospital (a White Plains hospital that closed in 2003) a few years ago and we lost United Hospital (New York United Hospital Medical Center, which closed in 2005), so now our choices are very limited and to get the care some patients may need we have to travel way out of our response area," he said. "I've seen problems with that."

Panelists identified unnecessary costs that need to be wrung out of
the system.

Some folks who do not have coverage or transportation tend to place 911 calls in order to get to an emergency room for care that a primary care physician should be providing.

Jeffrey Meade, the director of emergency life support at Phelps Memorial Hospital Center in Sleepy Hollow, said these folks know that they won't be refused care at the
emergency room.

"It's a tiny portion of the population but it does occur," he said.

He also said that in the past five years or so, hospitals face more requirements for emergency preparedness and meeting the requirements - many of which were imposed after the September 2001 terror attacks - costs money, he said

Daniel Blum, senior vice president at White Plains Hospital Center, made the point that fast-evolving medical technology can increase costs. It's human nature for patients to insist on the latest in diagnostic tests but the testing drives up the costs.  "If you have a stomach ache, you want a CAT scan," he said. "You wouldn't want a general  evaluation."