By Barb Arland-Fye
The Catholic Messenger asked five Catholic health care providers to share their views on the current state of the health care system and what can be done to improve it. Here are their responses to three questions we asked:
What works well now in health care, from your vantage point?
Dr. Pat Edwards, a primary care physician and member of Sacred Heart Parish in Newton: “Medicare. However, the Medicare advantage plans have provided large profits for insurance companies and little overall benefits for most Medicare recipients. I believe these plans were misconceived and should be phased out. The Medicare drug plans, however, provide many more people consistent access to relatively cheap but lifesaving drugs.
“Title XIX provides free and important care to pregnant moms and children. These families have access to adequate prenatal care as well as health care and immunizations for kids. Adequate access to these services (as well as other important programs such as WIC and Vaccines for Children) are crucial to a healthy population. Unfortunately, dental reimbursement in Iowa is so poor that many of the dentists simply cannot or will not participate. The reimbursement for other medical professionals in Iowa is barely at the break-even point. Hopefully our state and federal government will continue to address the issues which divert funds from these crucial programs. The other major program which is working well involves the various hospice programs in our state. I believe the concept of appropriate, comfortable and dignified end-of-life care is more readily accepted and acted on with the help of these programs.
Dr. Paul Ruggle, a primary care physician and member of Sacred Heart Parish in Newton: “I’ve been in family practice in Newton for 26 years. The advances in medicine are amazing. Now we can diagnose things we weren’t able to in the past. The testing is miles ahead of when I started practicing. The system of specialists is very helpful. If I can’t figure something out, I can work with specialists. The diagnosis you get is the right diagnosis and you get it quicker. It’s expensive, though.”
What works well now in health care, from your vantage point?
Dr. Mark Blaser, an allergist at Medical Arts Associates in Moline, Ill., and member of St. John Vianney Parish in Bettendorf: “If you are a sophisticated customer with decent insurance and you can navigate the system, you can get absolutely the best health care in the whole world, but that’s rarely accessible except by people who know how to seek it.” Even those who are poor, however, can go to an emergency room and get sophisticated care in at least a triage manner. “You may wait hours, but you won’t go out the door untreated.” Contrast that with the situation of a patient’s son who developed appendicitis while vacationing in Mexico. The family was required to prove it could pay $15,000 before being allowed to have necessary surgery, Dr. Blaser said.
Ann E. Young, vice president, Mercy Medical Center, Centerville: “Our ability to continue focusing on our mission of providing quality, compassionate care while working in collaboration with our physicians to meet the community’s health care needs despite the challenges we face in the current healthcare environment.
Lois Vogel, retired director of nursing/vice president of patient services at Skiff Medical Center in Newton and a member of Sacred Heart Parish there: “People are so much better educated about their health, thanks to the Internet and to the wellness and prevention education that’s out there. All of it is keeping us better informed and hopefully healthier. That’s part of our health system now — wellness and prevention … a majority of us are trying to eat healthier and exercise.”
What frustrates you most as a health care provider?
Dr. Pat Edwards: “The growing lack of access to reasonable care to increasingly marginalized groups. This includes the unemployed, especially those unemployed adults too young for Medicare. Access for the mentally ill is also poor, especially in rural Iowa. Currently much of the obstetrical care in rural Iowa is performed by family physicians. The number of new family physicians trained and willing to do obstetrics will fall drastically in the next 20 years. I suspect access to close obstetrical care will decline significantly in the relatively near future.”
Dr. Paul Ruggle: “I see a lot of resources spent on defensive medicine. Even though your gut tells you something is OK, you spend thousands of dollars on tests to protect yourself,” he said. And there’s nothing in the system that prevents a doctor from doing tests, he added. “It’s at all levels — the emergency room, specialists … the easiest course is to do the test, spend the money and then have an answer. A lot of these answers don’t really change the way patients feel or the way they recover.”
Dr. Mark Blaser: “What really frustrates me the most is people’s lack of insight, follow-up and care in their own medical conditions. This creates wasteful repetition of tests and unnecessary treatment that could be avoided.”
He noted that the existing health care system “rewards us for seeing more patients in a shorter amount of time. If that leads to you getting better slower or getting a test not needed, that’s not directly our problem.” And with low co-pays for medication, people don’t give a second thought to the actual cost of a medicine, he noted.
Ann E. Young: Among the challenges: “Increasing bad debt expense due to patients who have no insurance or who are underinsured and can’t pay for their care.” Another challenge is “our ability to attract new physicians and other providers as well as personnel shortages in the areas of nursing and other technical positions. Finally, continued increases in federal regulations which take resources away from patient care.”
Lois Vogel: “The biggest frustration is the continuity of care, the documentation, the computerization,” she said. “While there are many benefits to computerization, systems get outdated by the time everyone is onboard and then they have to start over with a new system,” she said. The other frustration is that as health care becomes more sophisticated, people need a good advocate, whether that is a family member or friend. Vital information can be missed without an advocate. “Either the patient is in pain or cannot absorb all of the information.”
What changes would benefit the way in which our nation provides health care, in your opinion?
Dr. Pat Edwards: “There should be some basic plan which covers routine and catastrophic coverage for all. The only way to make this work is to train more primary care providers. This will only happen if there are some incentives to seek a career in family medicine. Currently the number of students training in family medicine is only a small percentage of medical school classes. Regional inequalities built into Medicare reimbursement formulas need to be changed to encourage more physicians to practice in states such as Iowa. We currently have the worst reimbursement than any state. Tort reform should also be part of any solution.
Dr. Paul Ruggle: “There should be some way, in a country as rich as ours, to have a safety net for people who through no fault of their own end up out of work and out of insurance,” he said. “I’m one to listen to all options. There’s got to be something better than the hodge-podge system of insurance that exists now.”
Dr. Mark Blaser: “I think everybody having to pay something for the health care services they receive would make people pay attention and realize they have more of a voice. Many people don’t want to take the time to ask questions of their doctors because doctors get frustrated that they’re asking so many questions.”
Dr. Blaser suggests that patients write down questions, listen carefully to the doctor’s explanation and then ask follow-up questions. “We all have our self-interests at heart. It makes it almost impossible in discussions of health care and reform because everyone will point at the speck in someone else’s eye and won’t see the log in their own.”
Ann E. Young: “An equitable and uncomplicated system that allows those without insurance to access it in an environment where the burden of paying for it does not rest solely on reduction in payments to hospitals, physicians and other providers.”
Lois Vogel: “I’m very supportive of providing care or some sort of insurance system for those who can’t afford it. We’ve just got to do it. I worked at a free health clinic recently. It’s amazing the people who don’t have health care insurance and right here in Newton. It was mostly a younger population and it made me sad. It was people without jobs or who had lost them recently. Those people need help.”