Shands makes a deal with enemy of health reform

May 11, 2009

Hospital closing will benefit promoter of cash-register medicine.

As part of closing Shands at AGH, Shands has made a deal with Solantic, a private, for-profit corporation, to open an urgent care center in Ayers Medical Plaza (720 SW 2nd Ave.) right across the street from what is now a busy hospital but in October is slated to become an empty hulk.

Shands claims it has capacity to handle the extra emergency room cases at its Shands at UF facilities on Archer Road. When asked if Shands at UF had the ability to handle the approximately 700 births at AGH every year, Shands CEO Tim Golfarb told the Gainesville Sun “There is capacity, but it will be tight.”

About 17,000 of the 73,000 emergency room cases AGH and Shands at UF see annually could be cared for in an urgent care center, Goldfarb told the Gainesville Sun. But there are already several urgent care centers in Gainesville, including one run by Solantic at NW 39th Ave. near 43rd St. Emergency room patients have already decided they need to go to an ER. So it is unclear whether Goldfarb expects these patients to self-diagnose and sort themselves out, or whether Shands will be sending the new influx of emergency room patients to the new urgent care center.

Assuming those patients can afford it, that is. After negotiations with Shands, Solantic agreed to take Medicaid patients (big of them, considering they can bill the government, which is easier to deal with than private insurance), but all others must pay up front for services or provide proof of insurance coverage. As Goldfarb told the Sun in a May 9 article, Solantic “Is used to true retail business,” and “in fact they post charges right on the wall of the waiting area.” Because as we all know, if you’ve smashed a finger, it’s nice to know what it’ll cost you to have it set, that way while you’re waiting you can decide whether you really need it or not.

Adding insult to injury, the chair of the Solantic chain is Richard L. Scott, the disgraced former CEO of Columbia/HCA. Under Scott’s leadership, Columbia/HCA bought up so many hospitals it became the largest hospital chain in the U.S. Also under his leadership, Columbia/HCA was found guilty of the largest Medicare fraud in history and fined $1.7 billion dollars. Scott was not charged criminally, but the board of directors relieved him of his duties after the fiasco was revealed.

It would perhaps be enough to give us pause that Scott oversaw Columbia/HCA while it was defrauding the government and that his new company is now benefiting from hospital closures like Shands’ closure of AGH. But Scott is also a major opponent of health care reform, and has ponied up $5 million to launch a group, Conservatives for Patients Rights, which promotes for-profit medicine and maligns national health care systems in which health care is regarded as a right. The group denounces any attempts to pass health care reform from the Obama plan to more thorough plans like HR 676. (Check out CPR’s website at http://www.conservativesforpatientsrights.org.)

Running a chain of urgent care centers in this economic climate can’t be easy. Health care is expensive and a lot of people are losing their jobs and insurance and can’t afford it. Others have insurance that won’t pay, or carry high deductibles. Around 17 percent of us have no insurance at all. So an urgent care center might have quite a few customers (uh, patients) who can’t pay.

But as it turns out, Solantic might consider providing care to these people, as long as it can get its hands on some public money. The money it has its eye on in Gainesville is that collected by Alachua County’s CHOICES to provide some coverage those who work but can’t afford insurance.

So Richard Scott, enemy of health care reform, wants money that came from Alachua County’s small CHOICES health care reform effort, to ensure profits at this private urgent care center. All the while he’s spending profits from his medical enterprises to denounce any expansion of the public safety net, and trying to make people think national health insurance would be a nightmare.

Yes, that might seem contradictory. But the real reason characters like Scott attack anything provided in the public sector is that every time a public program is starved or destroyed it opens up opportunities for the private sector to suck more money out of our wallets. The less we have guaranteed in the public sector the more we will be forced to purchase in the private sector, and the more profits Scott and his ilk can extract from us. The fact that some number of people will not be able to access health care at all just serves as a threat to everyone else to keep working harder in a never-ending race to buy health security. But health care should be a birthright, as it is in many other countries.

Shands currently has an average 5-hour wait in the emergency room. One reason is that a lot of people can’t access care any other way. Another is that emergency room staff are spread thin and overworked. The Richard Scotts of the world benefit from our overburdened system when patients show up at his urgent care centers, trying to avoid these long waits.

Solantic claims it’s saving people money because they can get care cheaper at an urgent care center than they can at an emergency room. That may be true for particular minor injuries, but as hospitals close and minor injury clinics are substituted, we will pay a much greater price as the community loses the beds and facilities necessary for coping with real emergencies.

Unlike AGH, Solantic has no mandate to provide care if you can’t pay, so it can be ‘profitable’ by cherrypicking ‘profitable’ customers with easy, lucrative problems and leave the ‘inefficient’ public sector to provide care to the ‘unprofitable,’ the uninsured and the serious, complicated emergency cases.
Shands and Alachua County should tell Richard Scott and his for-profit clinic to take a hike. Instead of subsidizing his profits, we should continue to spend our limited public money to support already-existing entities, for example the Health Department and the Shands Eastside clinic. That way we won’t be subsidizing Solantic’s profits, and we won’t be paying to have lies about health care reform shoved down our throats by its chairman.

As for Shands’ closure of AGH, Goldfarb told a meeting of the Alachua County Medical Society that Shands spends $116 million in “charity” care a year, according to Dr. Caroline Rains, head of the ACMS. So that makes the $12 million that Shands estimates it loses every year from AGH seem like a small slice of the overall pie.

Everyone (except perhaps Richard Scott) agrees that the problem is not that we don’t have enough people who need medical care, the problem is too few paying customers, a problem that could be solved if the U.S. adopted a national health insurance system like most other industrialized countries. That way the 30% of each health care dollar currently diverted to private insurance companies’ profit, paperwork and bureaucracy could go to health care and health care providers. Instead of losing hospitals (where care is provided) we’d see insurance company offices (where care is denied) closing up.

Goldfarb didn’t show up on May 5 for a long-planned public meeting of the County Commission to discuss the closing of the hospital. His absence angered county commissioners, who had been expecting to have a dialog. In a private meeting with Gainesville Sun editors on May 8 he said “the barn door is closed as far as the hospital is concerned.”
(Printed in the Gainesville Iguana, May/June 2009. Thanks to Jack Price for alerting us to this story.)


Private health insurance companies—regulate them or eradicate them?

July 11, 2008

On June 19th, twenty of us from Gainesville, Florida traveled to Jacksonville to protest my health insurance company, Blue Cross Blue Shield. The effort was part of a nationwide protest of insurance companies, led by the coalition Healthcare NOW: Cigna in Philadelphia, Aetna in Hartford, Humana in Louisville, and many more. The biggest demonstration occurred in San Francisco, outside the meeting of “America’s Health Insurance Plans,” the insurance lobbying group dedicated to blocking health care reform. Malinda Markowitz, a leader in the National Nurses Organizing Committee, explained the protest: “These insurance companies… profit by denying care to our patients–not by providing it. The American people are ready for guaranteed healthcare, through great bills like Rep. John Conyers’ HR 676, and we will no longer let insurers and politicians block progress.”

In Jacksonville, passing drivers honked vigorously when they saw our signs, “Health Care YES, Insurance Companies NO” and “Honk if you’re mad at your insurance company.” We met lots of new friends, union members in Jacksonville who are supporting national health insurance. Bunny Baker, a Machinist, said that a Blue Cross representative called the union hall to say he understood why we might protest other insurance companies, but “We’re the good guys, we’re nonprofit.” She told him that Blue Cross was denying vital care to a friend of hers, making it hard to tell the difference. For my part, my Blue Cross premiums have gone up 57% in the last 3 years, so it’s clear that even a “nonprofit” health insurance company is incapable of providing coverage affordably. We need national health insurance!

So I was interested when on July 8th I received emails from four separate national groups promoting a new campaign for health care reform. One was titled “An historic day for health care,” and indeed it did seem to be. The new coalition is called “Health Care for America Now” (HCAN) and according to the New York Times it will spend $40 million on ads and organizing leading up to the election.

MoveOn.org Political Action wrote: “Today, for the first time ever, all the major grassroots groups in America that work on health care are coming together to take on the HMOs and private insurance companies.” The linked HCAN website declared “Which side are you on?”–“for a guarantee of quality affordable health care for all” or “for leaving us on our own to buy private health insurance.” http://healthcareforamericanow.org

It sounded promising. We certainly need to ‘take on’ the insurance industry. Our private insurance system is the reason U.S. health care is the most expensive in the world, not to mention inaccessible and stingy. The most comprehensive bill in Congress, HR 676, authored by Rep. John Conyers (D-Michigan), would kick out the insurance company middlemen. It would redirect towards care the money currently wasted on insurance company profits and paperwork. It would follow the lead of countries around the world which provide healthcare as a right.

But it turns out that for HCAN “taking on” the insurance companies doesn’t mean taking them out of our health care. Indeed, under HCAN’s plan, we would still be buying private health insurance. A brief inspection of the Health Care for America Now website reveals just the kind of tiresome incrementalism that hobbles U.S. struggles for national health care.

In fact, the plan espoused by the HCAN coalition seems to be very close to what Barack Obama and Hillary Clinton advocated all through the primary–regulate private insurance companies more, provide a mind-boggling patchwork of income-based subsidies (creating another layer of paperwork, tests and qualifications), and provide a public insurance alternative as a last resort. Worse, it continues to waste the money that could cover everyone. “The HCAN proposal forgoes most of the $350 billion annually in administrative savings possible under single payer national health insurance,” writes David Himmelstein of Physicians for a National Health Program (PNHP) http://www.pnhp.org/blog/2008/07/09/a-policy-response-to-health-care-for-america-now/

“The private insurance industry, as it functions today, clearly must be replaced with a system that works” says Don McCann, Senior Health Policy Fellow with PNHP. “So what is the solution proposed by the HCAN coalition? Let’s replace the private insurance industry with… the private insurance industry.”

There were other warning signs. In a press conference launching HCAN, Arlene Holt Baker of the AFL-CIO stated, “If we fail to enact comprehensive reform in the next Congress, employment-based health benefits–the backbone of our health system–will disappear in short order.” Most trade unionists have figured out by now: Job-based health benefits are precisely the problem. They burn up our power at the bargaining table, undermine our ability to speak out at work, make strikes even more risky and miserable, and lock us into jobs long past the date we might have been able to retire. Furthermore, if we’re too sick to work, we’ll lose our insurance, at just the moment we need it the most. Feminists chime in that job and marriage-based insurance makes a woman unnecessarily dependent on her husband–and his employer–for her health care. This is especially true if she is working part-time or raising children full-time. With true national health insurance, your health care doesn’t depend on what job you have, whether you have a job, or your marital status. This should be the goal. Instead, this campaign seems to be rallying us to salvage the current rotten arrangement.

It’s worth asking how we got to the point where groups that want to continue our private insurance system describe themselves as “taking on” the health insurance industry and advocating “guaranteed” health care. The movement to get private insurance out of our health care system has gained momentum as insurance costs have risen. Michael Moore’s film SiCKO introduced a whole new audience to the reality of well-functioning national health care systems in other countries. Unions all over the country have been signing onto HR 676–called a “single-payer” bill because the government (the ‘single-payer’) pays all healthcare costs. HR 676 has been endorsed by 33 state AFL-CIOs and 397 union organizations in 48 states. The U.S. Conference of Mayors signed on June 23. The funding mechanism, similar to that of Medicare, turns out to cost nearly everyone much less than they’re paying now, but allows for full coverage for the whole U.S. population. Around 90 members of Congress are signed on. Meanwhile, insurance company rate hikes and denials hit more and more people.

As a result, ‘taking on’ insurance companies is suddenly popular. Groups like MoveOn, which a few years ago would only talk about extending coverage to children, have changed their tune. But they still don’t get it. It’s not about extending our expensive and unreliable private insurance system to 47 million uninsured, it’s about abolishing a system that requires you to have “insurance” to get care. Private insurance companies make money by avoiding sick people. If you want everyone to get the care they need, you don’t regulate such entities, you eradicate them.

Traditional Medicare did just that for a market that the insurance companies didn’t want anyway: people 65 and over. The problems with Medicare were introduced by private insurers and HMOs, which have tried to entice away more profitable subsets of the elderly (only to dump them when they get expensive). As a practical matter, the Medicare experience teaches us that coverage and costs only get worse when private insurers are involved. HR 676 would essentially extend traditional Medicare to everyone, starting at age zero–and entirely eliminate the role of private insurance companies.

Contrast that to HCAN, which would leave insurance companies in place. “We need coverage that meets our families’ health care needs and is affordable, based on a sliding scale” their website states. “We need government to be an advocate for us and set and enforce the rules so insurance companies put our health care before their profits.” But a sliding scale means we have to prove our income–usually every year. And insurance companies are simply machines for making profit. Faced with new regulations, they just break the law until such time as they get caught, or can rewrite the law.

No wonder most people prefer Michael Moore’s admirably brief health care proposal: “1. Every resident of the United States must have free, universal health care for life. 2. All health insurance companies must be abolished. 3. Pharmaceutical companies must be strictly regulated like a public utility.”

Perhaps, you might say, well, it takes all kinds: There will always be the radical groups and then the more liberal groups. At least they’re doing something. What’s the objection?

My first objection is that the liberal groups in this case are cloaking themselves in radical language (‘taking on the insurance companies,’ ‘guaranteed affordable quality healthcare for all’) concealing their goals and suggesting they have more fight in them than they really do. They’re even using a confusingly similar name. The main coalition that’s been fighting for HR 676 is called “Healthcare NOW.” The new coalition is called “Health Care for America Now.” This trickery cuts off people who want fundamental change from those who are organizing for it, and diverts donations to what PNHP’s David Himmelstein calls “a placebo.”

My second objection is that HCAN is compromising away what people in the U.S. truly want, instead of joining the already existing fight to get it. For example, in a 2003 ABC News/Washington Post poll, 62 percent said they’d prefer a plan “in which everyone is covered under a program, like Medicare, that’s run by the government and funded by taxpayers.” Those who compromise the public’s interests always sell their watered-down programs by saying the public finds them more palatable. In reality, these compromises are more palatable to the nonprofit foundation complex many of these organizations represent. The majority in the U.S. want the insurance companies out–anything less is less than inspiring, and will lose support rather than gaining it.

My third objection is that their approach won’t work, even to get the measly reforms they seek. To win any kind of progress, there needs to be some threat. The gathering of organizations under the HCAN banner serves to reassure the insurance industry, not threaten it. And so reassured, the industry will continue to purchase politicians and conduct its murderous business as usual. It certainly won’t be put on the defensive.

The HCAN approach toys with, but then discards, the best leverage we have in the health care fight: The popular demand that insurance companies be kicked out of our health care system entirely. Eventually they will be, but it will be despite, not because of, the anemic plans of “Health Care for America Now.”

Go to http://www.Healthcare-now.org for the real deal. Go to Physicians for a National Health Program for great explanations and analysis: http://www.pnhp.org. Go to http://www.guaranteedhealthcare.org for the nurses’ take on the situation