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Health care hardships: Lack of insurance is biggest issue in health care
  
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By ROYCELYN BASTIAN
Health care and insurance are just two of the many issues that residents in the area are trying to decide on as the two presidential candidates try to solve the skyrocketing prices of heath care and the problems caused by nearly 50 million Americans without insurance.
But with a slew of factors affecting health care, a widespread lack of insurance is compounded by dwindling resources and staffing and a debate over the politics of medical coverage that lead many locally to believe the health care system is broken. This topic takes center stage in the race between presidential candidates Barack Obama and John McCain.
At Memorial Hermann Northeast, Dr. Frank Speidel, chief medical officer, believes lack of insurance is the major challenge that his hospital faces as well as the health care system as a whole.
He questioned how his hospital could provide health care for patients at a level that they should expect. Speidel explained that anyone who seeks health care without insurance in hospital emergency rooms will get the care that they need but unfortunately there will be less resources to provide to those who have insurance.
Allen Johnson, CEO of the Montgomery County Hospital District, said uninsured citizens put both businesses and health care providers on the losing end and patients having no insurance is a problematic cycle that needs to be fixed.
“People who do not have health insurance or are forced to self-pay for their services are shifting the cost and burden to those who have health insurance,” he said. “The cost of insurance increases, which means more businesses will not be able to offer insurance as a benefit and more people wind up uninsured.”
Johnson went on to say that access to health care services used to be the major problem, but it isn’t currently the case for those who have insurance. The cost of those services is now the major driver for inaccessibility to individual services such as mental health and trauma services.
“I feel that we need to enhance our trauma resources in the community,” Johnson said. “We have two great hospitals in our community that deal with issues such as cardio and strokes, but most of our patients who need trauma care are sent to the medical center in Houston.”
The issue of limited medical coverage is evident locally with at least 33 percent of the state’s uninsured residents living in the Houston area, according to Dr. John Zerwas, one of the chief medical officers for the Memorial Hermann System.
“It is a challenge for us to find a way to continue providing care in the community and still pull a positive bottom line,” Zerwas said. “There is a lot of concern on how people can maintain their insurance during these tough economic times.”
Zerwas questioned how medical facilities could continue to make money and help the community if resources and services are given to those without insurance.
“The government agencies, Medicaid and Medicare, do not pay for the entire cost of care and it becomes a burden for those who carry insurance,” Zerwas said. “If we are not able to drive a positive bottom line and make a profit, we will not be able to grow and bring new services to our communities. We will be limited in bringing in new technology and resources.”
For example, if medical services cost $100, hospitals will often charge $160 so they are able to make a profit. If the patient does not have insurance, then the hospitals have to eat the cost. If the person has Medicaid, facilities may only receive a small portion of the total cost with Medicare, Zerwas explained.
In 2006, the Memorial Hermann System in the Houston area collectively shouldered $147 million in unpaid or charity medical care.
Kingwood Medical Center told The Observer in April that its facility incurs $1 million a year in charitable care, which comes as a result of treating patients without insurance.
Lack of insurance does not just limit millions from receiving proper health care or keep medical facilities from making money; it also contributes to the shortage in staffing. In hospitals and other clinics across the country Zerwas said the largest cost is staffing and the second is supplies.
“In the industry, organizations look for bargains and deals for medical supplies to control the cost,” he said. “We also look at positions that we can eliminate without having a direct impact to patient care.”
In dealing with staffing, uninsured patients can deter some physicians and nurses from providing necessary care in emergency rooms or even working in the facility.
According to Dan Stultz, CEO and president of Texas Hospital Association, it is increasingly difficult to find specialized physicians to work for free.
“While Texas leads the nation in uninsured people, it affects everybody. If you go to a hospital in Texas where the uninsured population is high, doctors do not want to work it,” Stultz said. “If someone comes in with a head injury, it is very hard to get a neurosurgeon to come and provide care when only 30 percent of the patients will pay you.”
Stultz continued to explain that fewer nurses across the state worsens the situation as emergency rooms continue to be overcrowded.
With the 2008 presidential elections in nearly three weeks, many residents and health care facilities are waiting to see who will lead the nation and reform health care.
According to the Montgomery County Republican Party, the solution to the health care crisis is to have the system operate in a free market. Republicans believe the solution is to have people buy their own insurance and to make the policies in Texas the same as in other states.
“We need portable health coverage and to tailor it to the needs of the individual, which we think will reduce the cost of health care insurance,” said Dr. Walter Wilkerson, chairman of the Republican Party. “The more government is involved in health care, the more complicated and expensive it becomes. It just creates more problems and we don’t think universal health care is the best option.”
On the opposing side, Dr. Gary Miller with Kingwood Pines Hospital believes universal health care is the solution and that it will eventually be enacted.
“Universal health care will allow all citizens, especially those without coverage, some access to health care,” Miller said, who also pointed out that 47 million Americans across the county are without medical insurance. “It is sad to see people who can’t afford health care, but eventually we will get there.”
Amber Moon, press liaison with the Harris County Democratic Party, said the party’s solution to the increasing problem is to make health insurance less costly and readily available to more people.
“If we don’t make insurance more affordable, more people will be in the emergency rooms and it will cost taxpayers more money,” Moon said. “We need to increase the access and make it more affordable.”
Who is uninsured?
While the debate still lingers on illegal immigrants causing overcrowding in the emergency rooms and creating the burden for those who are insured, Dan Stultz, CEO and president of Texas Hospital Association, believes the majority of people without coverage are the working poor.
Texas, California and other southern states have a large influx of illegal immigrants, but for one illegal person, there are 100 uninsured people who are not, Stultz said.
“While the illegal immigrant population is growing, this problem is for the working poor. Studies have shown that at least 82 percent of families without insurance have at least one family member who is employed,” he said. “They just do not make enough money to buy insurance and their employers can’t afford to offer it.”
Stultz believes Texas leads the nation in this matter because of the fast growth population and a high service industry where people can’t afford coverage.
According to the Texas Department of Insurance, 76 percent of the uninsured are United States citizens, but 54 percent of non-citizens do not have health insurance. The department also states 66 percent of uninsured adults are employed with 44 percent working for firms with 25 or less employees, and 27 percent of them work for businesses with 500 or more employees.
- Roycelyn Bastian
The Observer’s series leading up to Election Day continues looking into the major presidential issues from a local perspective. As the series progresses, we want to hear from you about your thoughts on health care, energy policy or any other topic you think is important. Send your thoughts by e-mail to observereditor@hcnonline.com.
John McCain
Wants a system of health care in which everyone can afford and acquire the treatment and preventative care they need.
Plans to use competition to improve the quality of health insurance with greater variety to match people's needs, lower prices and portability. Families should be able to purchase health insurance nationwide, across state lines.
Believes that while still having the option of employer-based coverage, every family will receive a direct refundable tax credit - effectively cash - of $2,500 for individuals and $5,000 for families to offset the cost of insurance.
- from www.johnmccain.com
Barack Obama
Plans to provide affordable, accessible health care for all Americans, build on the existing health care system, and use existing providers, doctors and plans to implement the plan.
Wants to establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
Wants to require coverage of preventive services, including cancer screenings, and increase state and local preparedness for terrorist attacks and natural disasters.
- from www.barackobama.com
But with a slew of factors affecting health care, a widespread lack of insurance is compounded by dwindling resources and staffing and a debate over the politics of medical coverage that lead many locally to believe the health care system is broken. This topic takes center stage in the race between presidential candidates Barack Obama and John McCain.
At Memorial Hermann Northeast, Dr. Frank Speidel, chief medical officer, believes lack of insurance is the major challenge that his hospital faces as well as the health care system as a whole.
He questioned how his hospital could provide health care for patients at a level that they should expect. Speidel explained that anyone who seeks health care without insurance in hospital emergency rooms will get the care that they need but unfortunately there will be less resources to provide to those who have insurance.
Allen Johnson, CEO of the Montgomery County Hospital District, said uninsured citizens put both businesses and health care providers on the losing end and patients having no insurance is a problematic cycle that needs to be fixed.
“People who do not have health insurance or are forced to self-pay for their services are shifting the cost and burden to those who have health insurance,” he said. “The cost of insurance increases, which means more businesses will not be able to offer insurance as a benefit and more people wind up uninsured.”
Johnson went on to say that access to health care services used to be the major problem, but it isn’t currently the case for those who have insurance. The cost of those services is now the major driver for inaccessibility to individual services such as mental health and trauma services.
“I feel that we need to enhance our trauma resources in the community,” Johnson said. “We have two great hospitals in our community that deal with issues such as cardio and strokes, but most of our patients who need trauma care are sent to the medical center in Houston.”
The issue of limited medical coverage is evident locally with at least 33 percent of the state’s uninsured residents living in the Houston area, according to Dr. John Zerwas, one of the chief medical officers for the Memorial Hermann System.
“It is a challenge for us to find a way to continue providing care in the community and still pull a positive bottom line,” Zerwas said. “There is a lot of concern on how people can maintain their insurance during these tough economic times.”
Zerwas questioned how medical facilities could continue to make money and help the community if resources and services are given to those without insurance.
“The government agencies, Medicaid and Medicare, do not pay for the entire cost of care and it becomes a burden for those who carry insurance,” Zerwas said. “If we are not able to drive a positive bottom line and make a profit, we will not be able to grow and bring new services to our communities. We will be limited in bringing in new technology and resources.”
For example, if medical services cost $100, hospitals will often charge $160 so they are able to make a profit. If the patient does not have insurance, then the hospitals have to eat the cost. If the person has Medicaid, facilities may only receive a small portion of the total cost with Medicare, Zerwas explained.
In 2006, the Memorial Hermann System in the Houston area collectively shouldered $147 million in unpaid or charity medical care.
Kingwood Medical Center told The Observer in April that its facility incurs $1 million a year in charitable care, which comes as a result of treating patients without insurance.
Lack of insurance does not just limit millions from receiving proper health care or keep medical facilities from making money; it also contributes to the shortage in staffing. In hospitals and other clinics across the country Zerwas said the largest cost is staffing and the second is supplies.
“In the industry, organizations look for bargains and deals for medical supplies to control the cost,” he said. “We also look at positions that we can eliminate without having a direct impact to patient care.”
In dealing with staffing, uninsured patients can deter some physicians and nurses from providing necessary care in emergency rooms or even working in the facility.
According to Dan Stultz, CEO and president of Texas Hospital Association, it is increasingly difficult to find specialized physicians to work for free.
“While Texas leads the nation in uninsured people, it affects everybody. If you go to a hospital in Texas where the uninsured population is high, doctors do not want to work it,” Stultz said. “If someone comes in with a head injury, it is very hard to get a neurosurgeon to come and provide care when only 30 percent of the patients will pay you.”
Stultz continued to explain that fewer nurses across the state worsens the situation as emergency rooms continue to be overcrowded.
With the 2008 presidential elections in nearly three weeks, many residents and health care facilities are waiting to see who will lead the nation and reform health care.
According to the Montgomery County Republican Party, the solution to the health care crisis is to have the system operate in a free market. Republicans believe the solution is to have people buy their own insurance and to make the policies in Texas the same as in other states.
“We need portable health coverage and to tailor it to the needs of the individual, which we think will reduce the cost of health care insurance,” said Dr. Walter Wilkerson, chairman of the Republican Party. “The more government is involved in health care, the more complicated and expensive it becomes. It just creates more problems and we don’t think universal health care is the best option.”
On the opposing side, Dr. Gary Miller with Kingwood Pines Hospital believes universal health care is the solution and that it will eventually be enacted.
“Universal health care will allow all citizens, especially those without coverage, some access to health care,” Miller said, who also pointed out that 47 million Americans across the county are without medical insurance. “It is sad to see people who can’t afford health care, but eventually we will get there.”
Amber Moon, press liaison with the Harris County Democratic Party, said the party’s solution to the increasing problem is to make health insurance less costly and readily available to more people.
“If we don’t make insurance more affordable, more people will be in the emergency rooms and it will cost taxpayers more money,” Moon said. “We need to increase the access and make it more affordable.”
Who is uninsured?
While the debate still lingers on illegal immigrants causing overcrowding in the emergency rooms and creating the burden for those who are insured, Dan Stultz, CEO and president of Texas Hospital Association, believes the majority of people without coverage are the working poor.
Texas, California and other southern states have a large influx of illegal immigrants, but for one illegal person, there are 100 uninsured people who are not, Stultz said.
“While the illegal immigrant population is growing, this problem is for the working poor. Studies have shown that at least 82 percent of families without insurance have at least one family member who is employed,” he said. “They just do not make enough money to buy insurance and their employers can’t afford to offer it.”
Stultz believes Texas leads the nation in this matter because of the fast growth population and a high service industry where people can’t afford coverage.
According to the Texas Department of Insurance, 76 percent of the uninsured are United States citizens, but 54 percent of non-citizens do not have health insurance. The department also states 66 percent of uninsured adults are employed with 44 percent working for firms with 25 or less employees, and 27 percent of them work for businesses with 500 or more employees.
- Roycelyn Bastian
The Observer’s series leading up to Election Day continues looking into the major presidential issues from a local perspective. As the series progresses, we want to hear from you about your thoughts on health care, energy policy or any other topic you think is important. Send your thoughts by e-mail to observereditor@hcnonline.com.
John McCain
Wants a system of health care in which everyone can afford and acquire the treatment and preventative care they need.
Plans to use competition to improve the quality of health insurance with greater variety to match people's needs, lower prices and portability. Families should be able to purchase health insurance nationwide, across state lines.
Believes that while still having the option of employer-based coverage, every family will receive a direct refundable tax credit - effectively cash - of $2,500 for individuals and $5,000 for families to offset the cost of insurance.
- from www.johnmccain.com
Barack Obama
Plans to provide affordable, accessible health care for all Americans, build on the existing health care system, and use existing providers, doctors and plans to implement the plan.
Wants to establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
Wants to require coverage of preventive services, including cancer screenings, and increase state and local preparedness for terrorist attacks and natural disasters.
- from www.barackobama.com
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