Adventist Health Institutions Consider Future Impact of Possible Supreme Court Decision
by AT News Team
No one is willing to go on the record at this point. Adventist Today has been told off the record that there have been internal discussions among key administrators at more than one Seventh-day Adventist Church-related health institution regarding “what if” and the Affordable Care Act currently under review by the United States Supreme Court.
Many media news reports have pointed out that if certain provisions in the law are nullified the cost to health care providers could be massive. “Unless we are willing to let people die, we will have to continue to provide emergency treatment for those who have no health insurance,” reflected one veteran health care leader who is an Adventist Church member.
“This is a very complex situation,” said a young Adventist health professional. “Unfortunately it appears that the decisions are going to be made more from politics than driven by health care management or health promotion considerations.” There are Adventist health professionals who are willing to admit privately to views on both sides of the long-controversial health care plan. All of them regret that more attention is not given to prevention strategies.
The health care institutions sponsored by the Adventist Church have long been dedicated to charitable care and an emphasis on wellness. Depending on the exact nature of the Supreme Court’s decision, these developments could make it much more difficult for these values to continue. It should come as no surprise that competent managers are trying to anticipate outcomes and future developments.
Adventist Today is looking for sources willing to talk more openly about how the new law, the court decision and related developments affect church-related health care institutions. This will be a continuing story in future months.
Whatever happens to Affordable Health Care with the courts, U.S. healthcare funding is heading pell-mell to the plains of Megiddo.
The ethical issues will swamp the system as casualities mount. Every day it will be a new and different issue akin to the suffering Brits http://blogs.telegraph.co.uk/news/cristinaodone/100146838/why-should-fat-people-take-precedence-over-the-elderly-in-the-nhs/
I don't think anyone can really prepare for ACA, because no one really knows what it is going to look like by the time it's fully implemented in two years, should SCOTUS find it Constitutional. There will certainly be no less need for hospitals. No one believes that ACA is anything other than a halfway house toward a single payer system. Who will want to buy private insurance when the penalty for not buying insurance is less than the cost of insurance – and you can't be denied coverage when you need it, even if you have a pre-existing condition? And as the cost of private insurance skyrockets due to adverse selection, the government will have to step in and provide the only workable solution – a single payer option.
So the real question for Adventist health care, assuming we move closer toward government controlled health care, is this: Can we maintain our Adventist identity and mission under such a system? That is highly doubtful in my opinion. I wonder if anyone can offer insight on what happened to the Branson SDA hospital in Canada after Canada went to a single payer system. It is my understanding that the government took it over.
I strongly suspect that ACA augers the end of Adventist institutional health care as we know it, not because of cost/revenue issues, but because of church/state issues. All Adventist hospitals presently depend on the same sources of revenue as non-religious hospitals. They all need Medicare and Medicaid funds to survive. Medicare, Medicaid, and other insurers presently allow Adventist hospitals to offer services under their religious banner. But when the entire operation of Adventist health care is subject to the regulation of the federal government, it is rather unlikely, at least under administrations like Obama's, that we will get any slack.
What problems are projected that might unfavorably impact only Adventist hospitals? Won't the ACA effect all hospitals and service providers?
This certainly has no impact on those who are ill and sick as laws already in place require most hospitals and ERs to admit all needy patients.
Presently there are already in place several provisions of this act: no pre-existing condition can be denied insurance; and children under the age of 26 can be covered by their parents. How has this been working? Certainly, those who are now being insured under these provisions are not objecting.
Yes, this could very well pave the way to universal healthcare. When competition is squeezed, government payment may begin to look better. No one is objecting to Medicare and Medicaid and those are two government programs that are highly successful in elminating most of the administrative costs incurred by the private systems.
"when the entire operation of Adventist health care is subject to the regulation of the federal government, it is rather unlikely, at least under administrations like Obama's, that we will get any slack."
Are there separate regulations for Adventist hospital from all the others? What are they? What is seen as preventing continuation of their present practice? What church/state problems are foreseen?
Obamacare will likely be disastrous in terms of expense to the taxpayer. Indeed, it has become a political football and one wonders to what degree concerns for health are being really considered.
As Pelosi so famously said "We Have To Pass The Bill So That You Can Find Out What Is In It."
Where were the complaints of exessive expense when the U.S. went to war in Iraq and Afghan, the latter which has no end in sight?
This should be noted:
Over 3.6 million Medicare recipients save an average of $604 each, after the "doughnut hole" drug coverage gap was closed. And 2.5 million young Americans were able to remain on the parent's insurance plans until their 26th birthday–all "thanks to a federal law many of them despise."
Polls show that 50 percent of Americans oppose the healthcare reform law that "Republicans deride as Obamacare," but it has already brought benefits to millions of Americans in the two years since it became law. People with pre-existing conditions can no longer be denied health insurace, nor can insurers cut off coverage to the very sick.
Doctors, hospitals, and insurers are beginning to respond to the law's mandate that they "prevent illness rather than treat it," and costs are already coming down. As the Supreme Court wrangles over the individual mandagte at the laws's center, it's worth remembering why the law was passed: It will provide coverage to most of the 30 million people who currently have none.
As for the "free market" theory, when it comes to health care, the free market doesn't work. People don't make rational decisions about buying healthcare coverage, since they can't foreesee when they will get sick, or how much coverage thy will need. That is why every rich country in the world–and many not-so-rich ones–have decided that every citizen should have access to basic health care at much, much lower costs than we do, but American still views "socialized medicine" as foreign. Does anyone have a better solution?
How many reject Medicare? This is the example of "socialized medicine" which no recipient would give up. A similar program covering all the citizens with payroll deductions the same as Medicare, guaranteeing that an unexpected serious illness will not lead to bankruptcy. As our system now stands, we all are paying an additional $1,000/yr to cover the uninsured among us and if they are allowed to opt out of the proposed healthcare bill they will continue to be free-loaders.
One thing I do know is that without tort reform and relaxation of government mandates, no change will occur in healthcare costs. New interpretations of laws are making it possible to sue physicians and hospitals for smaller and smaller misjudgments, e.g. for an ER doctor who has never seen the patient going on a presumption of gastritis instead of ordering 50 different tests to rule out everything from gastric cancer to liver failure. Thus for physicians to cover their butts, more and more tests are done.
It will be impossible for a young man to buy a catastrophic policy because of the various federal mandates to cover everything from "women's health" to mental health to assorted other politically correct diseases from dollar one. The politicization of disease has become a huge issue to the democrats.
Tort reform has already been passed in California, but all the states have not.
One large health insurer in California, Aetna, has just raised its premiums 8% and there are no controls that can change it! The state board can complain, but unlike life insurance, home or car insurance where there are restrictions, healthcare insurance companies have none!
This will eventually drive people to realize that the requirement for all to have health insurance will be changed as they experience this. Only with a single payer like Medicare, can costs be controlled. I agree that forcing people to buy from a private company has real problems. In time, that will become clear, as it already has in California. Competition in health insurance, as in medical providers cannot be compared like buying cars or refrigerators (although some of the SCOTUS judges seemed to believe that).
The only possible way for health insurance coverage for all to be effective is to have everyone enrolled: the young and healthy and the old and ill (not yet covered by Medicare). This way the risk is pooled. Everyone, at some time, will need medical care, but we cannot know when. Buying it at the ER door is most impractical. If one can afford to buy and drive a car, he buys insurance as he doesn't want to risk the consequences of an accident. That is exactly why everyone should be required to have insurance. For the very poor there is subsidization offered. As it now stands, everyone needing medical care will be cared for; if they show up at the ER they cannot be turned away. But when uninsured, as many are, we the taxpayers pay for it in our higher insurance premiums.
Hospitals and medical providers have seen the future and have listed 45 unnecessary medical tests and procedures that add to total costs; such as MRI for ordinary sinus problems; CT head scan for fainting; yearly mammograms and PSA tests. Many of these lead to unneccesary and expensive treatments with out different outcomes.
No party should be accused of "politicization of disease." Everyone is most aware and either has a medical condition or knows someone who has been sick and without insurance. Republicans have no less sickness than Democrats. After all, the present Republican candidate enacted a bill in Mass. very close to the one that the current president has replicated–and it has been very successful there.
Elaine, you're comparing apples to oranges by talking about California on one hand but federal regulations on the other. Perhaps if California didn't have so many unfunded mandates Aetna wouldn't have to crank their prices up so high and more could afford it.
Enacting what works for one state may not work for all of them. And you're being particularly naïve if you don't believe that disease has been politicized, that certain diseases and health causes get more federal grant money than others, depending on which afflicted actress or actor has best been able to convince Congress to vote more money to the cause. How do you account for the fact that when I contracted healthcare-related tuberculosis I was required to take the medication in front of a health department nurse every day? If I had AIDS, privacy issues would be far more important than public health concerns.
Perhaps you know why Aetna was the only company, so far, who has raised prices–it may lead to others also raising theirs. The excuse of unfunded mandates as why more can't afford insurance is not substantiated. How does that affect health insurance?
No, states are all different but there is a general need in all states to present a practical plan for their particular state.
I am very aware of the publicity given various diseases, but to infer it is "political" infers that is the reason rather than individual organizations, not political government that operates these fund raising programs. Celebrities and many individuals and organizations "convince" Congress. One of the most effective methods is the $$$ that lobbyists line Congressmen's pockets. Is there a solution?
Breast cancer is a good example: more women die from heart disease than breast cancer and it is over-diagnosed often resulting in unnecessary surgery. It is pharmaceutical companies that "sell" diseases and medical conditions that their particular "drug" offers a cure. These are most frequently seen at prime TV hours–newstime. They even say "ask your doctor if this is what you need." The pharmaceutical lobby is one, if not the largest lobbying group in Washington and they really protect their turf. They fear that the government may soon negotiate for prices, as do the Medicare and VA. But Congress ruled against it. Guess why?
Then there are the generic drug manufacturers who are restrained from making generic drugs when patents expire. The proprietary drug manufacturers "bribe" them to hold off. Patients are those who pay.
It could bet ( I don't know where you live) that observing your taking medication is because some have only been dispensed and never took the medicine, causing more to be exposed. This happens especially in some immigrant groups who have a higher incidence of TB. While you were inconvenienced, had you asked, they might have informed you of their reasons.
Several years ago, a female patient with active TB was quarantined so she could be carefully monitored. I am old enough to recall being in quarantine several times for scarlet fever, diphtheria, and measles. That has changed with vaccines.
I know very well why they observe people – I realize that most TB cases are in immigrant communities and among the uneducated. I know exactly where I contracted it and when (latent from a known exposure from a co-worker 20 years previous). My point was the comparison between the care to prevent spread and guarantee treatment of one disease (TB) as compared to the that given the more politically correct disease (AIDS). I also realize it's easier to spread airborne pathogens (TB) vs. the more fragile HIV. HIV is an example of a politicized disease, i.e. one given special exemptions from the usual epidemiological standards that other communicable diseases are not spared.
But, with centralized care, rules make it part of the bureaucracy that EVERYONE must be observed taking the meds, no exceptions, one size fits all. Taxpayer money was wasted on my care with no allowance for the bureaucrats to recognize that some patients don't need daily monitoring for 6 months and can be trusted to follow med schedules. Everything the government decides the taxpayer pays for is done with political motivation. You don't think they won't dictate which treatments can be given for which problems and which treatments must not even be mentioned? Is it really that good to give the government that much control over our bodies?
I also could write a litany of the cost to taxpayers. As a Medicare patient (thank God) a recent hospitalization with many overcharges when I was admitted with long-term nausea and anorexia, dehydration. The first was a half-day ER visit, sent home after hydration.
Two weeks later with increasing symptoms, I refused to be discharged without a complete workup. Three days were spent on cardiologist-ordered tests, including cardiac catheterization with no symptoms relative to heart. (Guess how much that procedure cost?). It wasn't until the fourth day that AFTER stomach was perforated by ulcer that it was confirmed by CT scan and MRI–something that should have been performed initially!
With outcomes-based payments, several large medical institutions have shown
great savings by not ordering costly, exams simply to make certain there are no unseen conditions.
Now the problem: Had I been an uninsured patient, how extensive would their exams have been, and regardless, you and I would have paid. Distributing costs all around are far more efficient and perhaps the possible changes in healthcare payments may be a great inducement to "tighten the ship" and fee-for-service will be a thing of the past.
Doctors buy laboratories, build hospitals, purchase expensive radiological diagnostic equipment. Everytime that happens, there is a great incentive to "use" them which amortizes their cost. U.S. medical care needs overhauling.
"One-size-fits all" may be appropriate for certain diagnoses: simple appendectomies should be equally charged; ditto for many uncomplicated procedures. Already, medications are routinely prescribed for the same condition, isn't that "one-size-fits-all"? Why should C-sections cost twice as much depending on the geographical location?
Taxpayer money is wasted every time an uninsured patient shows up at the ER rather than doctor's office with a PA or NP. But, without insurance, they are left to use the ER as urgent care. Having insurance offers those patients preventive care that is not now being sought.
Don't blame the government–the insurance makes payments on their own criteria. Medicare is a government program and so it should decide when payment is made and many things it does not cover. But for the majority of privately insured patients, it is not the government making treatment choices.