Change of attitude needed to lower health-care costs

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My critique of the KRMC goal for health care that maximizes revenue rather than lowering costs used the Digestive Health Institute and the Orthopedic Clinic as examples. I thank Dr. Jaffe for the content of his response (Daily Inter Lake, Jan. 6), which only confirms my point. He tries to justify those higher costs, not provide solutions to lower them.

My example is sound. The fact is that office endoscopy is the same procedure, same outcome, same adenoma detection rate, and same or lower complication rate just done in a different location for a lot less money for 90 percent of patients. It is financially viable, even to the point that I charge less than what insurance is willing to pay.

Contrary to Dr. Jaffeís assertion that newer equipment is unaffordable, clips, balloons, etc. are used in office, absorbed as overhead, and not commonly necessary for the procedures done there. The fact that most gastroenterologists do not perform office endoscopy for the vast majority of colonoscopies and EGOs speaks mostly to their lack of motivation. This at a time when high deductible $2,000-per-month insurance premiums are becoming commonplace and 10 percent of Montanans are battling to get on Medicaid.

The attitude of the hospital board generated under the previous CEO and the persistent culture espoused by some of the physicians recruited to it leaves me with little hope for change. It is pervasive. From requiring general anesthesia for all hospital endoscopy, to lack of review of appropriateness of robotic surgery, to wealthy physicians getting their bad behavior rehab funded by the hospital, to refusal to use nurse anesthetists when safe to do so, the list goes on ad infinitum.

I cannot stress strongly enough that what makes this all possible is the total disregard and abuse of the people who pay privately or have health insurance. The quotes from the new CEO in the newspaper echo Dr. Jaffe ó state-of-the-art health care that Montanans deserve. There is no recognition of the financial crisis that patients and citizens face or the painful cutbacks and policy changes necessary to correct the situation. This leaves little hope for relief under his stead as well.

There is a simple solution to this intransigence both here and nationwide. The government protects Medicare and Medicaid patients by fixed payments for services that it determines to be reasonable. No billing beyond that is allowed. If itís right for 30 percent of the population, itís right for the rest of us.

Whether you like it or not, health insurance is a tax and thus subject to Congress. Merely contact your legislators and demand federal legislation to limit insurance billing to Medicare rates. Period. Health insurance premiums will plummet overnight and be extremely affordable.

Disregard the howls of physicians and dire warnings from health-care CEOs, which will be loudest from those pushing Medicaid expansion. They will either scramble to lower costs or have to work harder and make it up in volume. You may have to wait in line like the Canadians, but they are very happy with their health care, and we Americans are tougher than they are, eh?

Dr. Michael Boharski is a gastroenterologist in Kalispell.

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