News CoverageThe North County Times
Health care more costly, more elusive than ever
by MARTY GRAHAM
Nov 16, 2002
SAN DIEGO. Community officials gathered at a town hall meeting Friday concluded that getting people, particularly working people and children, the health care they need is more expensive and elusive than ever.
The panel, which included medical professionals, consumer advocates and business leaders, called for statewide and national solutions to delivering health care to working families and particularly children.
"At the local level, all of us have done our best to address the issue," said Steve Escoboza, the president of the Healthcare Association of San Diego and Imperial Counties. "But (a solution) cannot happen unless we answer the question, what is health care? A commodity, (or) a privilege, a right that belongs to everyone?' "
San Diego patient advocate Greg Noll won the only round of applause from the roughly 100 people who attended the meeting when he called for a constitutional amendment promising people the right to decent health care.
But the rest of the panel ignored Noll's proposed solution and instead spoke about the problems of a county where they said between 400,000 and 500,000 people are completely without any medical insurance or subsidies.
Panelists said that hospitals, health clinics, doctor groups and even the professions of nursing and doctoring are in a state of crisis in San Diego County.
The number of people without health insurance ---- and no way of paying for medical treatment ---- is large and growing bigger, panelists said, and health insurers do not reimburse doctors and hospitals enough for medical treatment.
"(San Diego Children's Hospital) is in crisis as an institution that is 50-percent reliant on Medi-Cal (insurance for payment)," said Blair Sadler, the hospital's president. "We cannot stand any more cuts. We've laid off people we need. We have four- and five-week waits for very sick children to see a specialist. Our emergency room was built for 25,000 patients (a year) and we now have 62,000 visits.
"That's unacceptable," Sadler said.
Panelists also said the insurance offered by the state for families ---- the Healthy Families Program ---- didn't work well for families, even before recent budget cuts caused by California's $24 billion deficit. The panel said more cuts to the program are expected in coming years.
Parents who want to enroll in the Healthy Families plan must pay a monthly premium and a co-pay, a price many cannot afford, panelists said.
"Ninety percent of our patients at the North County Health Services are (earning) below 100 percent of the federal poverty level," said panelist Irma Cota, "and we find poor patients are making hard economic decisions. Enrollment in the Healthy Families (program) is going down among our patients because they are opting to pay for insurance or to only insure some children and not others."
Cota is chief executive officer for North County Health Services, which manages 10 community clinics on the coast in Oceanside, Carlsbad and Encinitas.
However, while many of the panelists agreed on the problems, their respective solutions varied, and often reflected their particular interests.
For example, county officials, including Dr. Rodger Lum, head of the Health and Human Services Agency, and Supervisor Ron Roberts, said there isn't enough money in the system.
They said they want more state money with fewer restrictions and regulations.
"There has always been a feeling in the county that if you take all the various resources, the pots of money, and put them into one pot and spend it the way it's needed rather than the way it's required, we'd be able to do a lot more," Roberts said. "If the state and federal government would allow us leeway with their money, we could do a much better job."
In contrast, Jerry Flanagan, a health-care advocate for the Foundation for Taxpayer and Consumer Rights, said there was a lot of money in the system, but not enough financial monitoring.
Flanagan said the privatized system of managed health care did not make efficient use of the money in the system.
Flanagan said Medicare ---- the federal government's health insurance system ---- spends between 92 percent and 95 percent of all its funding on patient care, while health maintenance organizations only spend 75 percent to 80 percent of their revenues on actual health care.
Because of that, Flanagan said, there should be publicly funded health care that included careful monitoring.
"There's lots of money in the system, but many HMOs take 20 (percent) to 25 percent of the premium to cover administration and that means less money for nurses, less money for health care," he said. "We have to become more efficient at using the money we have."