Health Care/Grappling with coverage for all people

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By Jeff Kurowski
Compass Assistant Editor

"Health care is more than a commodity; it is a basic human right, an essential safeguard of human life and dignity."

The U.S. Catholic Bishops offered this statement in a 1993 document on health care reform.

More than 13 years later, statistics indicate that the lack of affordable health care remains one of this country's greatest injustices.

According to U.S. Census Bureau figures released in August of 2006, 46.6 million people in the United States were uninsured in 2005, an increase of more than a million people from the previous year. Bureau figures also show that more than eight million of those uninsured were children.

"Every politician will tell you that health care is the number one issue," said Jim Coller, administrator at St. Mary's Hospital Medical Center in Green Bay. "We need national health care. I don't recommend following the models of Germany, England or Canada. It has to be an Americanized version, designed and sponsored through tax dollars. We really need to pull ourselves out of private insurance coverage."

The Catholic Health Association is an advocate for a national health care plan, said Fr. Richard Klingeisen, coordinator of Health Services for the Diocese of Green Bay, and director of pastoral care and chaplain at Holy Family Memorial Medical in Manitowoc.

While there is support for national health care, at this time, movement towards comprehensive health insurance coverage is stronger at the state level, including Wisconsin.

"Whatever can be done to provide access to health care, whether it's on a state level or federal is important from a Catholic identity point of view," said Klingeisen. "Maybe it's (state level) the federal government's way of stepping back and seeing if it will work, finding some kind of model we can use."

"States will be given a lot of freedom to experiment," said Coller. "The key thing that needs to happen, because personal tax won't be enough to support the high cost of health care, is it's going to have to have corporate financial support systems. The catch-22 of that is some businesses won't go to these states. Somehow, we need to figure out that as people, we are each other's keepers."

Health care reform proposals continue in hopes of reducing the number of uninsured in Wisconsin, which compares favorably to other states. Census Bureau figures indicate that 9.8% or 540,000 people in the state did not have health insurance coverage in 2005. In Texas, for example, 24.2% did not have coverage.

Two proposals, the Wisconsin Health Security Act and the Wisconsin Health Plan, have drawn attention. The Wisconsin Health Security Act proposes the appointment of a task force to develop a plan to move Wisconsin to a centralized, state-run health insurance pool by 2008. The Wisconsin Health Plan proposes a blend of government involvement and market forces to extend coverage to the vast majority of state residents.

Preventive care suffers for those without insurance or people who have policies with high deductibles, said Coller.

"If you don't have the resources, what do you do?" he said. "They have to decide if they are sick enough to see a doctor. People in these situations are not living wholesome, healthy lives. A mother with five children and limited resources, for example, isn't thinking about a mammogram this year. She can't afford it, and it's not a priority. I'm a cancer patient, diagnosed in my 40s. I've often thought about what would have happened if I didn't have my job and my insurance benefits. That sense of worrying is too common for too many people."

Medicaid, which includes BadgerCare and SeniorCare, serves as Wisconsin's health care safety net. The medical assistance programs are funded with state and federal dollars that pay health care providers. The programs expand the number of people with health care coverage, but place burdens on hospitals, which lead to increases in health care charges, said Karl Appleton, chief financial officer at St. Vincent Hospital in Green Bay.

"For Medicare, health providers are getting reimbursed 45 cents on the dollar from the government," he said. "Government funding for Medicare is short 10 to 15 million dollars. If Medicare and Medicaid would pay dollar for dollar, we could reduce our overall charges by 25%. Medicaid used to pay 40 cents, then 30 cents, now 20 cents on a dollar. The charity care costs are continuing to grow. I have to raise prices 8% to offset the increase in expenses."

BadgerCare serves low-income families with children that do not qualify for Medicaid, which also provides for pregnant women, elderly and disabled. The increase in BadgerCare eligibility compounds the burden on health care providers, added Appleton.

"The problem I see with Gov. (Jim) Doyle expanding BadgerCare is that every time the state makes more people eligible, it does so without adding funds. We are going to drop down to a reimbursement of 18 or 19 cents a dollar. The pot of money has stayed the same, but the number of people in the program continues to grow."

"It's a difficult issue," he added. "Historically, the Sisters (Third Order of St. Francis, founders of St. Vincent Hospital) said, 'we want to take care of everyone.' That is our mission. We would just like to see whatever programs that are developed be adequately funded to cover costs. You can't create a public program and not fund it."

St. Vincent Hospital provided more than $19 million in community benefits in 2006 - more than $5 million in charity costs for bills written off by the hospital, and more than $12 million for Medicaid shortfalls. Appleton said he budgets for the costs, but it is becoming more difficult each year.

"Wisconsin is ahead of the game by having Medicaid, but we just aren't funding it," he said. "There is a rebellion from for-profit providers to get out of accepting Medicaid patients. We have already seen it in dental care."

It is a matter of "mission and margin," said Klingeisen.

"As Catholic hospitals, our mission is to take care of everyone, especially the poor and needy in the community," he said. "That's a challenge. You need a good mix in your community of people who have insurance and good reimbursement programs that help provide the necessary margins."

A shift in health care has also put financial burdens on providers, which can raise patient costs, said Klingeisen.

"Technology has improved so much that procedures that once required four or five days in the hospital now only require one day," he said. "There are small inpatient numbers today and more same-day surgeries. Some doctors are building their own walk-in surgery centers. They compete with hospitals. Financially, it has an impact on resources."

Business models used by for-profit providers limit health care access, said Coller. He pointed to last summer's closing of services at St. Michael Hospital in Milwaukee as an example.

"Half of the hospitals in America lost money last year," he said. "St. Michael's was losing millions of dollars, yet its emergency room was open to everyone. It's a sad commentary on the competitive model when those of us who care for the poor and needy are at risk. It's difficult when (for-profit) hospitals are negotiating deals with insurance companies. You're dealing with steerage, exclusivity. I'm an advocate for resuming the sense of service in America. At the end of the day, it's about the person on the street."

"I've been in Catholic health care for 35 years," said Appleton. "It's been very rewarding. Over the years, I have received notes from charity care people who are down and out, and cannot afford to pay their bills. It's a nice gesture when they send a note of thanks. I know that the Sisters want us to care for everyone, but we may not be able to do it for the next 100 years like we did for the last 100 years. It's getting harder and harder."