Friday, November 13, 2009

Public Hospitals and the Public Option

Does Contra Costa Health Services represent a "microcosm of a national single-payer health system?"

The following article was posted by the Oakland Tribune and ran in the San Jose Mercury News this week. With the permission of Drew Voros, I am posting the article it in it's entirety.

Voros: County hospitals already offer public option
Drew Voros, Oakland Tribune Business Editor
Posted: 11/10/2009 02:53:06 PM PST
Updated: 11/12/2009 09:00:30 AM PST

MARTINEZ — At the county hospital Thursday, they're having a talk titled, "Is it Rest in Peace for a Single Payer National Health Program?''

Considering the Contra Costa Regional Medical Center's growing popularity as a health-care option for residents, reports of the single-payer system's death on the local level are certainly premature. Taxpayer-funded medical services offered here represent a microcosm of a national single-payer system, including its being underfunded and set up to fail.

However, by making county hospitals the centerpiece of universal coverage in this country, we would prevent the need to reinvent the wheel. These facilities have become the de facto public option, so why not treat and fund them as such?

Like at county hospitals throughout the country, Contra Costa Regional Medical Center in Martinez is changing from the place of last resort for health care to the primary choice of many. Demand for its services is outstripping resources as unemployment and underemployment rise.

But even the fully employed come through the doors of county hospitals. Of the some 50 million uninsured in this country, as many as one-third of those choose to go the county-hospital route rather than pay hundreds of dollars a month in employer-subsidized health insurance such as Kaiser.

The "benefit'' of health insurance through employment really means you will get a subsidy, paid by the employer, that more and more workers shun because of the rising costs. We need to make premiums and/or co-pays cheaper for the populace if we want a successful health care system.

While Congress debates creating a public option for the health care industry to compete alongside the Kaisers and Blue Shields of the world, our elected leaders would be well served to examine how county hospitals could expand their role in achieving that goal. Clearly the facilities and personnel are in place. Missing is a system that provides adequate funding, and that's where congressional reform comes in.

Last week a majority in the House of Representatives approved a nearly $1 trillion health-care reform package. Before we waste billions of dollars establishing something new, we should utilize what we have.

Making county hospitals the headquarters for the public option in health care will not make it more or less attractive than private insurance, which of course will always be offered. What it will do is keep the most knowledgeable public health officials in charge of the public health dollars.

Standing outside the Martinez medical facility and ignoring the posted no-smoking rule, one Concord man said he didn't understand what was going on with health care in this country. While he did not disclose the reason he was there, "Bryan'' summed up the problem we face with health care in this country.

"It doesn't matter what they (Congress) do. This is where I will come for my health care because I can't afford insurance,'' he told me.

Sometimes you have to take the water to the horse.

Drew Voros is the business editor. His column runs on Wednesdays. He can be reached at
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In a previous post, I explored how systems like ours -Contra Costa Health Services (CCHS)- may already form part of the foundation of America's "Public Option."

You can find the original post here.

The new climate of change offers us the opportunity to rethink what our (government owned and operated health systems) "value" is in the nation. Are we a place where primary care plays a prominent role? Are we a perfect place to grow the primary care workforce? Are we an example of a publicly owned and operated health system that operates and co-exists in an environment with the private sector? Do we have something to offer when we move beyond the debate of "what" the national health policy will look like, to "how" we will actually reform our health systems at the local level? Questions to think about as we move into the era of reform.

More very soon

Here is the video that I included in my original post offering a friendly hello from some of us at Contra Costa Regional Medical Center.

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