Looking at how to fix healthcare, 29th District State Senator Jack Goodman met with professionals in the field during stops around the district on Wednesday. While Goodman put forward his view on approaching reforms, others raised concerns about other issues that need attention.
"There are no meaningful free market forces at play in healthcare," Goodman said.
In a situation where consumers seldom know the actual cost of care, Goodman said it is difficult to convert the patient into a consumer shopping for the best deal.
"In my opinion, creating more government involvement will not bring a better market at a better price," Goodman said.
Goodman spoke about reforms made to Missouri's Medicaid system shortly after he came to the Senate in 2005.
Doctors told Goodman the population did not drive healthcare. The attitude that "the doctor will fix it," rather than the patient being responsible, had led to people coming to doctors with no appointments, not keeping appointments, not following up on after-care and making the most expensive medical choices of going to the emergency room when sickness has reached a crisis level.
Goodman said the Senate tried to establish a range of co-payments for all patients in an attempt to establish a commitment by the patient to the outcome. The federal government reduced that amount. He also suggested tax incentives for those paying for private healthcare.
Scott George, a hearing specialist with Mid-America Dental and Hearing Center in Mt. Vernon, said the key to enhancing competition is to break the tie between health insurance and employment. The custom started during World War II and has kept people from shopping for better deals, like car insurance.
Goodman agreed small businesses are limited in seeking coalitions to qualify for lower insurance. States regulate their own insurance, leaving businesses like those in Joplin tempted to move a few miles to get better deals.
Goodman preferred keeping controls more localized but also advocated interstate compacts for insurance, which he did not think state law prohibited.
A number of medical professionals present raised issues about how insurance does not work. Dr. Jennie Gorham, an outpatient physician at the Missouri Rehabilitation Center in Mt. Vernon, complained that she was forced to bill a senior citizen the same rate as the insurance company, which discourages care that could avoid more expensive treatment. She proposed a menu of rates that could be used.
Dr. Cheryl Williams, an independent doctor in Mt. Vernon, said the lack of incentives for preventative care results in "fire hose medicine." She had a female patient who resisted getting a mammogram and finally ended up with a diagnosis of breast cancer, a much more expensive treatment. Williams wanted to encourage other businesses to follow the model used by Schreiber Foods in Monett of having a healthy lifestyle business plan, thus leading to better insurance premiums.
Mary Lemings, past Monett Chamber of Commerce president, said every private insurance company has its own formulary. Non-medical people are routinely telling people the medicine the doctor prescribed is not covered and the patient should try a different medicine.
David Eden, a pharmacist at the Missouri Rehabilitation Center, said there is no transparency in the drug business. It is impossible to know what kind of profits are being made. Rick Batson, Aurora city manager and past member of a panel seeking private insurance for the Los Angeles Police Department, said the same is true for insurance companies. He said insurance employees are taught to say no and how to enforce regulations, not how to provide a service.
"The patient does not feel like he has any allies," Goodman said. "He trusts the doctor and his hometown pharmacist. They don't trust anyone else."
Goodman said a forum on healthcare offered a way to exchange ideas without the clamor of those shown on television. Ending on a positive note, Goodman talked about the efforts of the Jordan Valley Health Clinic, which goes into schools around southwest Missouri to provide low cost preventative dental care. He saw great success by building on the clinic's model.
"To be told we have to embrace change or the status quo is a false choice," Goodman said. "We can see some things work well. The American people are pretty smart, frugal and able to take care of themselves. Where the government trusts people is where we see the best outcomes."
Goodman told The Times he found the forum helpful, especially where he heard pitfalls about programs he thought were working well.
"I wish the approach could be less partisan----my way or no way----and just work toward what works," Goodman concluded.