Candidate Forum column on health care, reforms was confusing
I am responding to Elliot Simon’s article in your Candidate Forum of June 18. Simon’s article is confusing on the facts about health care and health care reform.
His general point is that health reform in particular and government involvement in general is bad for West Virginia by controlling payment (“the doctors will leave”) and increasing costs to the State by mandating additional insurance coverage for its employees. He senses a conspiracy by “government and special interests” to hobble “for-profit” hospitals, based on their decline from 50 percent of hospitals in 1910 to 10 percent today, and blames the increase in costs on this decline.
There is too much here to address in a short letter to the editor so let’s focus on just two errors. First, he says that states are required “to provide a significant portion of Medicare funding.” I suppose it depends on what you mean by significant, but state funding for Medicare is pretty small and only for citizens who are eligible for both Medicare (old) and Medicaid (poor). Medicaid, by the way, is a joint State-Federal program. Since our fellow West Virginians are, on average, poorer than those in other states, the Federal share of the costs is on a formula that sends more to West Virginia than to all but one other state. Bottom line, many Federal dollars flow into West Virginia to pay for our health care.
His point that “government has taken over hospitals” is also confusing. In West Virginia 18 percent are government owned, 25 percent are private for-profit, and 57 percent are private not-for-profit. This latter ownership category includes all of our churches and civic organizations like Rotary, the Shepherdstown Men’s Club, our Shepherdstown Library, Shepherdstown Day Care, and our Volunteer Fire Department. All those good citizens would be surprised to hear they are working for the government and in fact they are not. Our local hospitals in Martinsburg and Charles Town are part of the WVU system, which, in spite of its name, is neither owned by state government, managed by state government, nor financed by state government. But what if it was? Hopefully Mr. Simon doesn’t see WVU as an ill-conceived government intrusion.
I don’t know if Mr. Simon’s competition is for “single payer,” I don’t even know if I am. The devil is in the details. But I do know that it’s important to connect the dots. In 1910, heck, in 1960 most old people and poor people did without much health care. Too many of us are today. That is what “market failure” means. To tolerate it may be penny wise, but it is surely pound-foolish.
(The author was vice president for policy at the American Hospital Association, executive vice President of the Michigan Hospital Association, a professor of hospital administration at the University of Michigan, and has consulted widely on health system organization and financing both in the United States and many foreign countries).