How to get genuine health reform for Georgia

(AJC Photo / Hyosub Shin)

(AJC Photo / Hyosub Shin)

By the time this week is over, dozens of bills will have been sent to Gov. Nathan Deal’s desk. He will sign most of them into law, adding and deleting hundreds of lines from the state code.

What all of them have in common is that none of them will help repair a health care market that is disintegrating faster than we’d like to believe.

Obamacare, as sweeping as it was, and even if it weren’t so wrong-headed, isn’t a big-picture answer. Obamacare doesn’t address a looming doctor shortage. Obamacare is silent on the question of states’ certificate-of-need laws.

While Georgia hasn’t expanded Medicaid as envisioned by Obamacare, that would not be much of a salve, either. An expanded Medicaid wouldn’t do anything about low reimbursement rates that keep many health providers from taking Medicaid patients in the first place.

As health officials acknowledge in private, Medicaid expansion most likely would leave even safety-net hospitals with high rates of uninsured patients worse off financially than they have been historically under so-called disproportionate-share payments — which Obamacare is set to slash. It would be a mere band-aid for rural hospitals that suffer from low rates of privately insured patients who pay full freight.

The problem with trying to fix health care is that it’s typically done by pulling one lever here and another there, in the hopes that a flat-lining system will be miraculously cured. Health care is too far removed from anything resembling a rational market for one or two fixes here and there to make a difference.

In the past few years, our state has employed commissions of appointed experts to take the long, broad view and recommend a series of reforms to criminal justice and, beginning this year, k-12 education. The criminal-justice group’s work has been widely acclaimed, and the education commission is by all accounts off to a promising start.

Georgia needs to take a similarly long, broad and sustained look at health care.

We need people who will look at insurance and access, yes, but at other aspects as well: Incentives for bright young minds to become doctors, and the educational capacity to enlist as many as we need; licensing and scope of practice for other health professionals; the creation of health care networks tying together rural areas with failing hospitals; the further expansion and strengthening of Georgia’s telemedicine and charity clinics to help fill in gaps; and encouraging the opening of more health facilities by loosening the state’s relatively strict certificate-of-need laws.

There’s more, but that’d be a pretty good start.

What these, and any other, issue areas have in common is that their successes would be mutually dependent. That’s why they can’t be done very well alone. They need to be considered collectively, and that’s more than we can expect from our annual 40-day sessions without an overarching effort to string them together.

And that effort probably needs the backing of a governor. The reforms from Deal’s criminal-justice commission have enjoyed more legislative success than similar endeavors by task forces created by the Legislature itself.

If it doesn’t fit into the rest of Deal’s tenure, it ought to be in the sights of anyone already looking ahead to 2018.

Reader Comments 0

50 comments
skruorangeclown
skruorangeclown

Excellent article but reforming Reagancare and cost shifting in the ER not a priority and may infrige on GOP pledge of allegiance to Grover and Heritage folks on no tax increase. Why not just ban free ER for illegals and force them to suffer and/or  die or better yet just   return  home? Itis called self deport.

hamiltonAZ
hamiltonAZ

An honest examination would have to consider whether the responses from other states to the ACA have generated unexpected benefits for those states and their citizens.

MHSmith
MHSmith

No matter what is done the means of funding healthcare has to change to pay for the increases,Kyle. Thinking that by simply reforming the past or present system and making cuts will cover the costs is not going to work.

straker
straker

The only way to fix our broken healthcare system is to adopt the Canadian or British model and provide fairness for all and take away the huge profits the current healthcare system is making off the backs of the American people.

Nick_Danger
Nick_Danger

There is no "market solution" for health care, because there is no "market" as the word is commonly understood.

Say your doctor sends you to a specialist for abdominal pain, and the specialist determines that your gall bladder must be removed.  He wants to schedule you for surgery next Wednesday.

But no, you say!  You're going to go to the "market" to get the Best Deal, right?  You're going to contact each area hospital, find out how they bill the surgery, anesthesia, facility charges, nurse care, supplies, etc., compare success rates and surgical experience, making allowances for non-equivalencies in service and outcomes, right?

Not a chance.  I doubt it can actually be done, and I would bet money that the amount you expected would still not be within 20% of the amount you pay.

Kyle_Wingfield
Kyle_Wingfield moderator

@Nick_Danger You ignore that the lion's share of health spending, in aggregate, is not on emergencies but on care for chronic diseases. The CDC says chronic diseases account for 86% of health spending: http://www.cdc.gov/chronicdisease/

And yes, we can expect people to act like consumers for that kind of care.

jezel-dog / Coach - me
jezel-dog / Coach - me

@Nick_Danger Why not ?  1. increase the number of doctors....different scholarship incentives for every specialty. 2. create economic incentives to build and operate more hospitals 3. encourage the creation of more pharmaceutical  companies with tax breaks

IReportYouWhine#1
IReportYouWhine#1

The only thing that needs to be "looked at" is getting government out of it and returning it to a true free market, competition based system. Not only are we currently paying for doctors and hospitals, we are also paying for the vast and mindless bureaucracy and their cronies in the insurance industry.


That's 50% savings right there^^.

ALibNotToBeMessedW/
ALibNotToBeMessedW/

@IReportYouWhine#1

"True free market."  Does not exist.  Never has.  Never could.  Next.

But I agree with you in re: bureaucracy and cronies and insurance industry.  We should ban health insurance companies.

WilJohnson
WilJohnson

States which have expanded Medicaid are seeing a growth in private investment, infrastructure and jobs in rural areas because there is a financial footing to build on. Georgia should not have let political roadblocks stand in the way of providing the pathway to basic healthcare for all Georgians, and especially for our elderly, our children and our poor.


We always have to remember that Georgia ranks 40th or so out of 50 in almost everything, so CON issues, doctor recruitment, rural healthcare and nearly everything else have been chronically underfunded for years. There is no need to study this at all.  Just look to the states with significant rural populations in the top 20 and do exactly what they do. This is not rocket science. This is about Georgia's will to invest in its' future.

India and Pakistan are already filling our suburban doctor shortage needs and will fill rural general practioner needs with the right incentives. Few Americans will do it because the same insurance companies who gutted the ACA by removing the public option and national insurance pools have made being a specialist the only way to go. Fee for procedure.


It is astounding to hear people talk about government taking control of their healthcare when Medicare, Medicaid, Prescription Drug Coverage and Veterans Care cover so many Americans.  Why no outrage about insurance companies who love having those 50 state bureaucracies? Doesn't anyone remember DRGs, HMOs and PPOs?





Caius
Caius

Important topic. I have no problem with Kyle's suggestion. Such has worked before.

Over the decades we created a for profit health care system.  And immediately started trying to govern it.

There is a state Insurance Commissioner in Georgia.  Why? There are fifty states and all 50 govern insurance. Not to mention the feds! 




JackClemens
JackClemens

That would be an excellent start. Thanks for raising these issues. Work needs to be done.

LogicalDude
LogicalDude

Single payer would solve a lot of these problems as well. 


But it's too sweeping of a change for a single state to implement.  It would have to be nationwide and complete. 

Kyle_Wingfield
Kyle_Wingfield moderator

@LogicalDude What does single payer have to do with permits for opening new medical facilities, preventing a doctor shortage, keeping up medical facilities in rural areas? Nothing. Arguably, it would worsen some of these.

sneakpeakintoeducation
sneakpeakintoeducation

@Kyle_Wingfield @LogicalDude


Where is your proof for that? I lived in a country where single payer system was in force (like every other industrialized country out there) and none of what you say is true in my case. What it did do was provide care for everyone, no matter your background, give you the opportunity to go private if you wanted to pay out of pocket (at no more cost than most of our insured people pay for out-of-pocket WITH insurance), and ensure that all emergency treatments for a variety of diseases were provided with a high level of care and expertise without worrying about losing your home to pay for it. My father had a stroke and spent 17 weeks in the hospital in a specially designed ward for stroke patients. He received physical therapy, speech therapy, occupational therapy and round the clock nursing care without any direct cost to him or the family. Afterwards, he was recovered well enough to return home and live independently. I could tell you more stories of wonderful care family members received after cancer diagnosis' but this blog isn't long enough. You are saying that this would be worse than what we have now?

Kyle_Wingfield
Kyle_Wingfield moderator

@sneakpeakintoeducation I am saying, among other things, we would still have rural communities that didn't have enough people in them to support a hospital, and that this wouldn't change just because everyone was paying something if that "something" was less than the cost of service, as Medicare and Medicaid currently are.

I am saying single payer does nothing to help rationalize Georgia's system of determining which medical facilities should be built and which ones shouldn't.

I am saying single payer likely does nothing to alter the incentives for bright young people to become doctors -- at least, nothing positive.

Btw, not "every other industrialized country out there" has "single payer." Many of them -- including Germany, Switzerland and the country where I lived for 4.5 years, Belgium -- instead have insurance mandates.

LogicalDude
LogicalDude

@Kyle_Wingfield @sneakpeakintoeducation So, "no better, no worse" under your assumptions for single payer versus what we are doing now.  


Gotchya. :) 


But hey, if you have answers for those rural facilities, let the governor know. Do other states have that same issue? If so, is it funding or is it something else? 

LogicalDude
LogicalDude

@Kyle_Wingfield @LogicalDude "nationwide and complete" means it would take everything into account.  


Doctor shortage?  - make medical school free. (or have other incentives).  I've read where the "doctor shortage" is by design. A limited number of spots in medical school to limit number of doctors. It will always be a struggle under any system where you may have too many doctors in one area versus other areas.   If you make a Teach4America type incentive where medical school is free if you go wherever they send you, even a rural office, then that can be another possibility.  


Rural medical facilities? - paid by taxes like any universal healthcare plan. 


permits?  - seems to be a state issue with funding and coverage. Mostly funding. Funding by healthcare taxes would ease up to see where coverage should be. 

sneakpeakintoeducation
sneakpeakintoeducation

@Kyle_Wingfield @sneakpeakintoeducation


Yes, they have mandates that work better and are much more efficient than the system we have in place. Why is it that the country I lived in spent next to nothing on marketing their product but we, as a private health care system, have to pay huge amounts of money within our premiums to cover marketing (35% of our premiums covers the cost of marketing!!) and lobbyists who go to the capital to ensure that their interests in making massive profits. How is that beneficial to the patient? Regarding the rural system, the governor has shown that he cares not a whit about serving our rural communities and the less fortunate. 


Regarding the doctor situation, why do the other countries with a single-payer system find that they have doctors in the system? There are plenty of ways to ensure that they practice their craft in a universal health care system. You have not shown anywhere in your statement that an exodus would happen.



Kyle_Wingfield
Kyle_Wingfield moderator

@sneakpeakintoeducation "You have not shown anywhere in your statement that an exodus would happen."

You don't get it. There'll be no exodus because there's hardly anyone left to leave.

MarkVV
MarkVV

@LogicalDude 

Let’s say that a single payer system might solve many of those problems. Because of the basic simplicity of the system, as opposed to the extreme complexity of ACA, there would be a better chance to deal with problems like doctors’ shortage.

sneakpeakintoeducation
sneakpeakintoeducation

@Kyle_Wingfield @sneakpeakintoeducation


I am talking about the exodus of people from the profession and/or medical school IF universal health care were to be instituted. 


I do get it, you cannot state unequivocally why universal healthcare would mean that it would cause harm to our citizens. It would only cause harm to the huge profits of the health care industry.


Kyle_Wingfield
Kyle_Wingfield moderator

@sneakpeakintoeducation "It would only cause harm to the huge profits of the health care industry."

And there it is. This is really about attacking profits.

In fact, from insurers to hospitals, margins are pretty slim in the health industry. They are fatter in the pharmaceutical industry, but those firms also take some of the biggest risks and face some of the highest regulatory costs in the health sector.

sneakpeakintoeducation
sneakpeakintoeducation

@Kyle_Wingfield @sneakpeakintoeducation


Yikes, one mention of the "meager" profits that the poor insurance companies make and you have to yell that it's an attack on poor old capitalism. I am all for making profits on business ventures but when the profit motive of a company is to deny care to the sick and needy or to engage in all out war with the patient who may be suffering from life-threatening diseases, something is wrong. We know there have been plenty of whistle-blower testimony from the industry who have confirmed that there number one task in their job was to deny claims in the hope that the customer would give up the fight and go away.  There are huge profits made by this industry and to suggest otherwise is being willfully ignorant and assuming that the readers are dumb. The top brass make huge amounts of money and bonuses. 


In 2014 the industry made profits of $2 billion and you consider it peanuts.

http://thinkprogress.org/health/2013/04/19/1894641/unitedhealth-medicare/

http://fortune.com/2014/08/06/15-most-profitable-business-sectors/


What you obviously don't want is for everyone to have access to fair and affordable health insurance, where the customer isn't gouged left, right and center. It is the least transparent system I have ever know and the inflated costs of healthcare are out of control. To suggest that charity clinics fill the gap in rural areas suggests that you want to take things back to the Victorian era when you have to go cap in hand begging for "pennies" from the kindly guvnah. It is a shameful thought that this is how you suggest healthcare services should be run in a country of our means.

coj
coj

Republicans recognize that our health care system was screwed up but didn't want to do anything to fix it. They believe that the free market system will fix it. Has the free market system fixed anything ever?

MarkVV
MarkVV

“Obamacare doesn’t address a looming doctor shortage.

ACA addresses the doctor shortage (which may be exaggerated by those who have a vested interest) in several ways. Among them it has provided funding for nurse practitioners and physician assistants, who can make the physicians more productive, and their number is growing. Further, the shortage of doctors is greatest in some areas, such as rural. ACA provides bonus to those doctors who practice in such communities.


 
“An expanded Medicaid wouldn’t do anything about low reimbursement rates that keep many health providers from taking Medicaid patients in the first place.”


ACA provided for a two-year Medicaid-Medicare pay parity, thus increasing the Medicaid reimbursement rates. It is up to the Republican-dominated Congress to extend the parity (if they have not done it yet in the last few days).


The doctors’ increasing shortage is real and has little to do with ACA. The irony is that those complaining about it and about ACA not doing enough about it are often the same ones who complain about the cost of ACA – as if those measures taken to reduce the shortage cost no money.

RandroidWillBoy
RandroidWillBoy

All good points.  This bill fails to address access issue and no true insurance is included.  When you can't underwrite to specific exposures, insurance this is not.  As long as people are fooled into compariing only "premium" to total maximum cost including co-pay, the disingenuous propoganda will continue from those so gullible.

RafeHollister
RafeHollister

As long as we look to government for the answers, the longer we will be frustrated with the meager results.  The CON regulations are one example of government being the problem.  We need more competition and less crony price fixing. The CON results in a balkanization of rural health care.  One corporation moves in and buys up all the competition in their geographical area and then uses government to eliminate competition.  Prices then rise as patients have no choice.


Medical schools seem to be stuck in the past, back when they tried to limit the number of doctors so that demand/prices could be kept high.  Now there is this need, they don't seem able to respond, so most of our doctors are now imported.  We need more medical schools and more medical students.   You shouldn't have to be MENSA qualified to be a PA, working under a trained MD.


Obamacare was developed for the wrong reason, to grow government control over the medical establishment and make us more dependent on government.  Almost none of the promises of Obamacare have been realized.  It needs to be tossed on the ash heap and replaced with something more patient/doctor focused that increases availability and reduces costs of treatment.

PJ25
PJ25

While Georgia hasn’t expanded Medicaid as envisioned by Obamacare, that would not be much of a salve, either. An expanded Medicaid wouldn’t do anything about low reimbursement rates that keep many health providers from taking Medicaid patients in the first place.

==========

^^^This is not what the same ten bed wetting Medicaid loving liberals posting here on the AJC keep telling us. 

DawgDadII
DawgDadII

@Andy123 Empirically speaking, I've seen pretty convincing evidence Medicaid is far too easy to get signed up for, wide open for fraud.

RafeHollister
RafeHollister

@DawgDadII @Andy123 Not to mention that there are several studies out there, that claim that often the medical outcomes for people on medicaid are often worse than for people with no insurance.

coj
coj

@DawgDadII @Andy123 There is way more fraud and a lot more money involved among the vendors and not the recipients of Medicaid. You're claims are as bogus as republicans claiming to have a replacement for Obamacare.

DawgDadII
DawgDadII

@coj @DawgDadII @Andy123 My claims are NOT bogus. And I'm not going to go into details, but there are people, given an option to use available private health insurance paid for by someone else or enroll in Medicaid (fraudulently) choose the latter.

FIGMO2
FIGMO2

Novel ideas put forth ^^^ there, Kyle.

The problem with most of our liberal friends is they place more value in a novel written by some thoughtless politician looking to promote himself above all else. 

DawgDadII
DawgDadII

As long as government persists in attempting to engineer "health care" (i.e., the flow of profits and political advantages) the systems and markets will be a mess. They already have thousands of pages of law and regulations no one fully comprehends. Eventually, when enough people cannot get quality health care, they will wake up and take back the marbles.

AvailableName
AvailableName

You are right that the ACA as it is structured today, even with an expansion of Medicaid won't fix healthcare in Georgia.  But your proposals, like crucial infrastructure investments aren't going to happen magically.  Money is needed and the amounts needed aren't going to result from an expanding economy.  Georgia's leaders hate taxes but they will have to be increased to do what you propose be done with healthcare and infrastructure.

Kyle_Wingfield
Kyle_Wingfield moderator

@AvailableName "But your proposals, like crucial infrastructure investments aren't going to happen magically."

I never said they would.

MANGLER
MANGLER

@AvailableName Too many people here suffer from feeling separate from "them".  Getting Georgians to love thy neighbor (even if they are transplants from up North) needs to happen before any big issues can actually be resolved.

jezel-dog / Coach - me
jezel-dog / Coach - me

Good article Kyle and a topic we need much discussion about. The average person...like myself.., has trouble understanding the issues...much less having a solution.

 Had we done our homework a few years ago there would be no need for national health care. Obomacare simply fills a void. We all know a free market can do a  better job than the government can do.

MANGLER
MANGLER

@jezel If that were true, then the market would have created solutions on it's own by now, don't ya think?

Kyle_Wingfield
Kyle_Wingfield moderator

@MANGLER There is no "market" in health care, in the usual sense of the word. Too much interference between buyers and sellers.

Nick_Danger
Nick_Danger

@jezel @MANGLER 

When you're in that ambulance after a heart attack, be sure to "shop around" for your best deal!