Democratic congressional candidate Paul Davis hosted a round-table discussion with a dozen area health care professionals Thursday in Pittsburg.
Davis, who is locked in a neck and neck contest with political rookie Steve Watkins (R-Topeka) for the 2nd District seat soon to be vacated by U.S. Rep. Lynn Jenkins, aimed two questions at those who attended last weeks forum at the Community Health Center of Southeast Kansas: What are the greatest challenges you face in the current rural health care environment? And what are the best possible solutions?
Davis, a Lawrence attorney and former Kansas House minority leader, didnt say much on the day; he was there to listen. My job, said Davis, is to synthesize [your accounts] and turn them into action and policy. I think we have to acknowledge that we have a great health care system in this country, but we have a costly health care system that has a lot of challenges, and were just not meeting those challenges right now.
THE HOUR-LONG discussion included a nursing home administrator, a pharmacy owner, a couple of primary care doctors, a handful of hospital administrators, two CEOs of health-related non-profits, a District 3 representative from the Kansas House, and one attorney.
The answers were as diverse as the group itself, but key concerns did emerge: the difficulty accessing health care, especially for the rural poor; the lack of affordable health care; the at times onerous federal regulations that descend on small hospitals and health clinics, as well as the frequent inability of these larger policy-making bodies to acknowledge in legislation the vast differences between a large, wealthy, urban hospital and a small, poor, rural one. Several participants Thursday urged Davis, if successful in his Nov. 6 bid, to advocate for a wiser health system that recognizes that it cant hold a small hospital in Fort Scott to the same template of expectations as it holds a critical care center in Wichita.
Reta Baker, the president of Mercy Hospital Fort Scott, was on hand to address this issue directly. The challenge that small rural…hospitals have is regulation, Baker told Davis. Were held to all of the same regulations that a large hospital is held to, but our reimbursements, our payer mix the percentage of hospital revenue received from private insurance companies versus government insurance versus self-paying patients is very poor in our communities. In addition to the inequitable reimbursement scheme, continued Baker, there is the exorbitant cost inflation that characterizes so much of the health care industry but which is felt more keenly in small, rural hospitals, where revenue pools are shallower. When we talk in our community about the cost of health care, hospitals and providers take the blame for that. But why are our costs what they are? MRIs, CT scans, hospital beds. Do you know the cost for a hospital bed, a plain old hospital bed? People dont realize the cost that goes into that.
A major step in driving down medical costs for the consumer, argued Baker, is to first address the corporate intermediaries responsible for every year increasing the cost burden for the health care facilities themselves. Why does an MRI [machine] have to cost $2.1 million in this day and age? Why does a hospital bed cost $14,000 to $15,000 a bed. And all the regulations that require that your bed do all these magic things….
Baxter Springs-based pharmacy owner Brian Caswell sees the profit-at-all costs mentality at work in his industry, too, and he urged Davis to support legislation that brings greater transparency and oversight to the pharmaceutical trade. Caswell cited a recent example of a drug manufacturer who, in a bid to maximize profit, arbitrarily increased the cost of an essential drug used primarily for children and the elderly from $100 or $200 to $2,000.
Caswell called such action morally reprehensible and told Davis that the antidote to these bad actors is to put more sunshine on [the industry], allowing people to see where the money is flowing to and from. This, Caswell believes, by contributing to lower drug costs, will allow for greater access to medication. Because pricing, said the pharmacist, is still probably the biggest barrier to health care.
Thrive Allen County CEO David Toland and CHCSEK CEO Krista Postai reminded Davis and those in attendance that whatever gains have been made in the field so far, those in positions of authority must, even in the face of sometimes hostile winds, remain vigilant in pursuit of the fair health care outcomes that theyre in the business of advocating.
Toland pointed to Allen County, where Thrive has helped reduce the uninsured rate from 21 percent to 9 percent. But with attempts by the administration to strangle the [Affordable Care Act], theres no money coming out to support navigators individuals trained to help consumers find the best Marketplace health plan and no money coming out to support outreach. So, last year, where we had six navigators at Thrive, well have one this year. Thats simply not sufficient to meet the demand and so I think theres a lot of concern that these tremendous gains that weve made…throughout southeast Kansas are going to be lost this year.
Postai, citing the increasing poverty in this corner of Kansas and its grimmer-than-elsewhere mortality rates, agreed. I thought at one point that we were turning the ship. Were not. The ship is turning back around. Were the greatest country in the world I hear this every day and yet we have kids in hunger. There are practical, legislative responses that can be invoked to combat the ills that affect populations like the ones served by CHC pouring more attention and more resources into behavioral health care for starters, said Postai but theres a revolution in outlook that has to take place first.
People look at these folks as if theyd invited poverty into their house, as if theyd invited lack of education into their lives. Ive always told people, Nobody wants to be poor, nobody wants to be out of work. There are always a few people who abuse the system but theyre very, very, very few.
