Health-care reform

Cape Cod Times Editorial
July 15, 2008

Another round on the health-care battle, featuring Sen. Edward Kennedy's dramatic return to the Senate chamber after brain surgery, played out in Congress last week. The administration, facing a towering Medicare deficit, reduced doctors' reimbursement by 10.6 percent, which naturally would drive doctors away from Medicare and youths away from medical careers.

Democratic and some Republican senators agreed that was a bad idea. They proposed instead to save money by cutting the subsidy of the gold-plated Medicare Advantage program. The insurance companies that run the program countered with heart-touching testimony from elderly clients, about a fifth of the Medicare total.

But a veto-proof 69 votes were cast for the medical community at the expense of the insurance industry - just perhaps, a harbinger of real change.

It's certainly long overdue. We pay far more for care than most other nations and get less benefit. The World Health Organization says that life expectancy is better in 23 countries and infant mortality is lower in 37 countries - including Canada and the United Kingdom, home of much-derided "socialized medicine."

Whatever the U.S. health insurance industry says, we cannot boast of "the best medical care in the world." Two people who know this all too well are Stephen Abbott, the retiring CEO of Cape Cod Healthcare, and Richard Salluzzo, the new CEO. As veteran community health administrators - Abbott managed Cape Cod Healthcare nine years and Salluzzo has for four years led the not-for-profit Wellmont Health System of nine medical centers in Tennessee/Kentucky/Virginia - they have a bird's-eye view of health care problems.

To cherry-pick from recent interviews of Abbott in this newspaper and of Salluzzo in the Kingsport, Tenn., Times-News, they agree on two major reforms:

A single-payer health insurance system, which they believe would shrink the millions of dollars wasted on battalions of insurance executives and armies of clerks, and shift the focus from paperwork to actual medical care.

Abbott told reporter Robin Lord that "most of his colleagues" share his support of a single-payer system, be it government or a private entity. Salluzzo told his interviewer that "more than 50 percent of doctors and hospital administrators are favorably disposed" to such a system.

A way to prevent investment in expensive buildings and machinery unless an unmet need is proven.

Abbott lays some of Cape Cod Healthcare's financial difficulties on the proliferation of stand-alone centers that can do surgical procedures quicker and cheaper. Of course they can - they're not burdened with the mandates that hospitals have. Sen. Robert O'Leary's legislation would level the playing field and deserves quick approval.

Salluzzo would go a step farther. Since studies show that outpatient centers increase the number of surgical procedures, the question arises: Are they all necessary? A single-payer system, in his view, would restrict unnecessary consumption and cut costs.

Salluzzo pinpoints other problems: a pending physician shortage, an illogical Medicare payment formula. Much needs to change; last week's Senate vote was a good sign.