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Stakes too high not to reform health care system |
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By Sara Criger
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Wednesday, 12 August 2009 |
Not since Harry Truman was president has our nation been so close to the sweeping changes that can — if done correctly — transform health care to the benefit of everyone.
 Opinion
Sara Criger
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For St. Joseph’s Hospital, the sole Catholic hospital in the Twin Cities, the prospect of improving how health care is delivered makes this a time of genuine hope, albeit tempered by our concern that more harm than good can result if reform efforts fall short.
The core of our hope centers on the prospect of embracing the
objectives necessary to transform the U.S. health care system
compassionately and effectively.
These are the same principles the Catholic Health Association of the
United States is advocating tirelessly to integrate into reform. They
include: access for all, with special attention for the poor and
vulnerable; an emphasis on prevention; patient-centered care throughout
the lifespan; cost-effectiveness; transparency; quality and safety; and
sufficient and fair funding for providers.
This echoes the priorities articulated by other respected voices,
including the Institute of Medicine, the private, non-profit
organization that serves as a national advisor on health.
We can do it. Moreover, we must.
Access for everyone
We must start by answering the moral and ethical imperative to cover
everyone. It is a matter of respect. No longer can we operate in a
system where disparities — ethnic, socio-economic and those that
accompany a diagnosis such as mental illness — remain part of the
accepted norm.
Yet, today, access to quality health care is apportioned inequitably
among the haves and the have-nots. For all the rancor heard in
criticism of other countries for “rationing,” we’ve lost sight of the
fact that our existing system rations health care regularly.
At St. Joseph’s Hospital, we see the results every single day.
For so many who live among us — especially the poor, the mentally ill
and the marginalized — life often moves from one crisis to another.
Lacking consistent access to preventive medicine, they frequently delay
seeking medical care until their condition necessitates a trip to our
emergency room, often followed by hospitalization. This exacts a
pointlessly expensive toll on health care resources; this translates
into higher costs for all of us.
We can’t go on this way. The same goes for the greater incentives our
system offers to treat injury and illness, rather than hard-wiring
wellness and health into the way care is delivered. Strategies that
create good outcomes are the underpinnings of real reform.
A common-sense solution, which is gaining prominence, is called a
“medical home.” A medical home addresses our distorted delivery of care
and reimbursement by emphasizing prevention and primary care. A key
goal is for people to work with their physicians to stay healthy. A
focus is on identifying and treating precursors of illness, such as
obesity and smoking, so people’s conditions don’t deteriorate into
illnesses that require more acute, expensive care.
But at St. Joseph’s, we’re concerned that when the shouting subsides,
what emerges will be a watered-down initiative that’s reform in name
only. If it is merely cutting around the edges, nothing will have been
achieved. In fact, we will simply spiral further into a chaotic
tailspin that jeopardizes the ability of hospitals to care for those
who need us.
That will happen if reform simply reduces reimbursements and shifts
costs to hospitals. It’s underway already in Minnesota, with the
governor’s pending cuts to General Assistance Medical Care stripping
basic coverage away from the neediest among us.
Reduce costs, improve quality
Like Minnesota’s other non-profit hospitals, we’re legally and
ethically obliged to treat those who come through our doors, no matter
their ability to pay. We take seriously our responsibility to manage
costs effectively; continued cost-shifting, though, places a burden
upon us that not even the most prudent stewardship can overcome.
Reducing costs and improving the quality of care does not have to be
mutually exclusive. Both objectives can be reached, particularly if we
are motivated by wisdom, innovation and an unrelenting commitment to
health and healing.
Those are the same virtues that keep St. Joseph’s, your Catholic
hospital, as vibrant today as we were at our 1853 founding by the
Sisters of St. Joseph of Carondelet. We know good things happen when
principled people take on even the hardest work.
Real health care reform can happen. We can do it. In that, and in so much else, St. Joseph’s Hospital has faith.
Sara Criger is CEO of St. Joseph’s Hospital in St. Paul.
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