As the recession deepens, doctors and hospitals are reporting that hard-pressed patients are deferring elective surgery, even as others are speeding up non-urgent procedures out of fear that they may soon lose their jobs and health insurance. Delaying elective procedures can have serious medical consequences, as when a detectable polyp develops into a tumor because a patient skips a colonoscopy. Some hospitals said their emergency rooms were already seeing patients with dire conditions that could have been avoided had they not deferred surgery for economic reasons.
The Obama administration is signaling to Congress that the president could support taxing some employee health benefits, as several influential lawmakers and many economists favor, to help pay for overhauling the healthcare system. The proposal is politically problematic for President Obama, however, since it is similar to one he denounced in the presidential campaign as "the largest middle-class tax increase in history."
Long cast as villains for denying coverage or refusing to pay for treatment, insurers now are representing themselves as indispensable partners in a healthcare overhaul. In their pitch to lawmakers, the companies say they are in a unique position to help improve quality and root out waste, saving money so everyone can be covered.
Next month, thousands of people will be on their own as communities cut non-emergency health services to illegal immigrants and more local governments are forced to make similar decisions. The Pew Hispanic Center estimates that of the 11.9 million illegal immigrants living in the United States, about 59% have no health insurance. That accounts for about 15% of the nation's approximately 47 million uninsured.
Telehealth, or the use of Internet, video and telephone to connect doctors and patients, is expanding in Wyoming and across the country. This month, the state passed a law giving the Wyoming Department of Health's rural health office the authority to work with other states and organizations to lay the groundwork for more telehealth exchange.
You've been distracted, so you can be forgiven for not paying attention.
Much of your focus lately on the government front has been centered on the $19 billion that the government will spend on healthcare information technology. You've also probably been paying a lot of attention to the healthcare reform ideas in President Barack Obama's 2010 budget. Those two issues represent potentially the two most drastic changes that healthcare has faced in the past several years, so it's understandable that you haven't spent much time thinking about perhaps the most important challenge to your hospital or system's labor relations—as well as its balance sheet—in your lifetime.
If you haven't figured it out by now, I'm talking about legislation making its way through Congress called the "Employee Free Choice Act." Sounds great, doesn't it? Of course, most bills coming out of Congress sound great if you're only reading its title. In crafting legislation, congressmen and women could give even the most savvy consumer advertisers a lesson or two on puffery and outright lies. But in this bill, I don't know if I've ever seen a more flagrant case of false advertising.
Right now, most of you are probably operating non-union hospitals, and you're probably happy about it. Those who do have unions on campus won't say so publicly, and I don't blame you, but I know from off-the-record conversations that you'd change places with your nonunion colleagues in a New York second. We've all heard horror stories about nurses who won't work and other healthcare workers who have no fear of being fired for gross incompetence because the union protects them. But at this moment, at least the decision on whether to bring a union in to negotiate for workers has been a free and fair secret ballot process overseen by the National Labor Relations Board. If management is being unfair to workers, they can expect an organization attempt and an election they can expect to lose.
This bill attempts to change that by taking away the election component of a unionization attempt. Under the bill, only 50% of workers with similar responsibilities in an organization need sign a "card" in order for a unionization to take place. You'll hear it talked about as a "card check" process. Think of it as a petition.
Why is this process unfair? Well, for starters, it opens workers up to intimidation on the part of the union attempting to organize workers. It also fails to protect workers' right to privacy. Under card check, the identities of those who want the union will be open for all the world to see. The converse is also true.
How would you feel if there was a bill to make public your vote in national elections? Local elections? What if you voted for the losing candidate in a mayoral or city council election? Think there wouldn't be retribution? Think again. The first time you call that city councilman you didn't vote for with a complaint about a pothole on your street, you'll be on that enemies list, and you'll know I'm right.
Unions have been taking on healthcare with increasing alacrity in recent years as their core constituencies at manufacturers have dwindled due to offshoring. I don't have a problem with unions' attempts to organize hospitals. Healthcare is attractive to unions because it's a growth industry, and it can't be offshored very easily, even though a few folks are traveling to lower-cost overseas destinations for elective surgeries.
I don't mean this column as anti-union. Certainly if unions had never formed, we'd still have low-paid workers slaving away in coal mines and sweatshops with no benefits, little protection, backbreaking hours, and even smaller wages. Just take a look at China if you doubt me.
I'm all for organization if 50% of employees feel that management is doing such a poor job of handling employee concerns that a union is necessary. The very threat of it keeps management in check. Similarly, the secret ballot election process keeps unions in check—preventing them from intimidating workers into supporting organization attempts.
Under the card check system, they'll know who the supporters are and who to put on the enemies list. I have yet to hear a convincing argument about how this bill would make the union organizing effort fairer, or freer, than what we already have.
It is incongruous that a president who makes so much of healthcare's inefficiency and high cost would support this legislation: But make no mistake. If this bill reaches the president's desk, he will sign it. He said so in the campaign last fall. And with a heavily Democratic Congress, chances of its passing are greater than ever.
Lobbying groups, such as the American Hospital Association, are fighting against it, but it's your job to contact your congressman and make sure card-check legislation never happens.
Philip Betbeze is finance editor with HealthLeaders magazine. He can be reached at pbetbeze@healthleadersmedia.com.Note: You can sign up to receiveHealthLeaders Media Finance, a free weekly e-newsletter that reports on the top finance issues facing healthcare leaders.
President Obama promises to use information technology to cut medical errors, avoid unnecessary tests and procedures, and identify better treatments. And his administration is betting that $19 billion of the economic stimulus package will spread the concept from coast to coast.
A North Texas lawmaker has moved to kill a troubled program that was supposed to improve care for about 78,000 elderly and disabled Medicaid patients. A bill by state Sen. Bob Deuell, R-Greenville, calls for the state to end the integrated care management program in 13 counties and sever its contract with the Evercare unit of UnitedHealth Group. The state has fined Evercare repeatedly and ordered it to increase staff and fix other problems, but lawmakers have continued to receive complaints about the program.
A nonprofit will be able to expand services at its new Gloucester, MA, community health center thanks to $1.3 million in federal stimulus money. North Shore Community Health was among the 126 health centers nationwide receiving a collective $155 million from the American Recovery and Reinvestment Act.
Democrats and Republicans are battling over whether the government should establish a Medicare-style public insurance option for people under 65. Top Republican senators declared in a letter to President Obama that they would oppose any healthcare bill with a public plan because it would force insurers to compete on an "unlevel playing field" with the government, which could theoretically set artificially low prices and subsidize any shortfalls with taxpayers' money. The issue will be among the most difficult Obama will have to address as he seeks a sweeping healthcare overhaul.
