The cost of health care

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In light of the exorbitant cost of health care, I find both a letter of non-apology from the KRMC board and a news article/advertisement for the Digestive Health Institute in the same issue of the Daily Inter Lake interesting. The desire to provide great health care is not nefarious. The question is whether or not you can afford KRMC’s vision of great health care. As an aside, ever wonder where the $24 million to pay their fine came from?

Let us place this question in some context. There are four items for you to consider. One, nearly 20 percent of GDP is spent on health care, a percentage both liberals and conservatives acknowledge is too high, although they disagree on how to lower it. The equivalent of nearly $11,000 for every man, woman, and child in the U.S. The equivalent of over $3,000 from each citizen of the Flathead County goes to KRMC alone. With an average per capita income of $40,000 in Montana that is a hefty amount. That is money you don’t have for retirement, education, caring for aging parents, housing , etc.

Two, health care funding is essentially compulsory by taxation for Medicare, Medicaid, Tricare, and yes even your insurance as Justice Roberts informed you. Third, only a very small percentage of patients actually go out and price health care. Those that do are often thwarted. The vast majority just go where their doctor sends them and with low deductibles or mandated coverage they could care less as long as their insurance pays the bill.

Finally, a collaborative arrangement of outpatient services exists between physician investors and the hospital that creates investment returns for the physicians and revenue for KRMC / NWHC which essentially has a monopoly in the Flathead Valley. Since many of those doctors are employed by or contractually obligated to KRMC, a potential conflict between the hospital’s and subsequently their own self interest as opposed to the financial interest of the patient exists. A perfect stewpot.

With that background in mind, let’s take the KRMC board at its word. Their mission is to provide you and as much of Montana, Canada, and Idaho as possible with great health care. To do so requires a lot of revenue because that vision is inherently inefficient as it underutilizes both specialist physicians and equipment in this geographic area. So, whatever interferes with obtaining that revenue, even if it lowers the cost of health care despite the same quality outcome, has to be opposed.

Case in point is what happened to the Flathead Valley Orthopedic Clinic. By moving outpatient surgery to their own facility, they saved patients thousands of dollars per procedure. Not wanting to lose that revenue because it interfered with their vision, the hospital countered by hiring competing surgeons at overcompensated salaries by the government’s own measures and directed all ER patients to their own group.

The hospital administration even refused to seat Dr. Al Olszewski a medical staff position for which he was duly elected. FVOC could not compete with the deep, and as we have seen “allegedly illegal”, pocket of KRMC and is now within their fold. The result is the consumer now pays thousand of dollars more for outpatient orthopedic procedures so the hospital can get its revenue and doctors can get their return on investment.

A similar arrangement exists for the Digestive Health Institute. It is a fact that over 90 percent of gastrointestinal endoscopy can be done in an office instead of a facility. It is a fact the over 90 percent of endoscopy can be done without general anesthesia which adds extra costs without any medical benefit. And it is a fact that office endoscopy can be done for less than half the cost of facility based endoscopy.

We’re talking millions of dollars in savings. Rather than encourage that practice, you build a $12 million facility that allows you to highly compensate physicians, with a view that appeases people while they wait for their loved ones, and keeps the revenue stream and investment returns flowing.

Medicare, Medicaid and many insurance companies have mandated coverage for endoscopy procedures so patients don’t always see the bills. Those that have to pay out of pocket do however and are shocked and rightly so.

Imagine if you will orthopedic procedures that cost $8,000 instead of $12,000. Imagine endoscopy for $800 instead of $2,000 or more. Imagine many other ways the cost of health care can be lowered. In a time of prescribed reimbursements, hospitals, doctors and others in the health care industry are banding together to preserve and expand their incomes. There is a mentality out there to pluck the golden goose of private insurance until she dies. The resultant hike in premiums is driving more and more people into the socialized medicine camp. Instead there should be efforts at innovating ways to lower costs and even more importantly encouraging the empowerment of consumers to decrease the cost of health care. The goal should be maximum savings, not maximum revenue.

There should be more circumspection on what is truly fiscally responsible in the arena of health care for this area. You can bury your head in the sand and laud the government, hospitals, doctors and insurance companies for doing all they can to provide the most efficient, least costly and best health care for you, but maybe, just maybe, they aren’t.

To be certain there is expertise available in Kalispell that would not be here without KRMC’s machinations. But can we really afford to have or even need a Mayo Clinic replica in every small town in America? Especially if it means that KRMC and its physicians have to resort to stealing the cigarette money of low and middle income Montanans to keep their head above water? A bit of irony there, no?

The greatest single driver keeping people on Medicaid is health-care costs, KRMC keeps costs high, and then lobbies for the expansion of Medicaid.

Years ago physicians came to this valley for less money because they loved it, not for the 95th percentile of national compensation. They cared what health care cost their patients, stayed independent, and did all they could to keep it lower by providing a counterbalance and challenging the hospital when necessary.

Times do change. Now they are employees, insist on the highest possible salaries, and are generators of revenue to ensure that income.

They are good people, excellent physicians, and I would entrust my life to them. But that does not mean they are immune to fiscal irresponsibility.

The ridiculous cost of health care is potentially remediable, not by an inexorable march to socialized medicine, but by empowering the consumer and for physicians and hospital boards to alter their way of thinking.

How to do that and whether the consumer even wants to be empowered is a subject for another day.

— Dr. Michael Boharski, Kalispell

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