WAOW - Newsline 9, Wausau News, Weather, SportsSpecial Report: Healthcare reform from a local perspective, part I

Special Report: Healthcare reform from a local perspective, part I

by Meg Bonacorsi

WAUSAU (WAOW) -- The health care reform debate weighs heavily on the minds of many of us.  And rightly so.  If a bill passes, it will impact all Americans.

We wanted to know what local people in the health care industry think needs to be done. This series begins by talking with providers.

Of all the issues facing the healthcare industry, area providers say underpayment for Medicare and Medicaid patients is their biggest challenge.

Duane Erwin, President and CEO of Aspirus Wausau Hospital says, "Health reform is not the same as saying we're going to repay our providers, our hospitals, and physicians less- you figure it out. And basically that's the way this is playing out at this point."

President and CEO of Marshfield Clinic, Karl Ulrich says, "The government pays us through Medicare and Medicaid programs less than what it costs us to provide care. So what do medical systems do? They cost shift that loss into the private sector. Which is why those who are insured, keep seeing premiums going up."

But the consequences don't stop there.

Irwin says, "People have to start looking at closing down programs that aren't profitable, you may have some physicians or other practitioners retiring because it just isn't worth it."

The way the system currently works, certain places, like Miami for example, get reimbursed at a higher rate for Medicare and Medicaid patients. And local providers say that's a problem.

Ulrich says, "You see an explosion of care occurring in those areas where they get paid more. Interestingly enough, most of the studies show that really great, high quality healthcare, the best in the country is in Minnesota and Wisconsin where we get less for providing that care... Making sure the physicians and other providers are doing the right thing, doing the right tests, not duplicating tests, not over ordering x-rays. There needs to be a challenge put down to the health care industry that says you guys need to be paid for quality not quantity of care."

As for the heavily debated public option, local providers aren't exactly supporters. While they want as many people as possible to have access to affordable health care, they think it should be provided through employers. Because the public option may bring on the same problems that Medicare and Medicaid do.

Irwin says, "We can't afford that. There are going to be unintended consequences."

Ulrich says, "If you have a public option that pays poorly to providers of care, what I'm fearful of is certain systems may say we're not going to take that clientele anymore even though they've got insurance."

Providers say we as patients are also part of the solution.

"People who drink, smoke, don't exercise, are not healthy, they have a responsibility to take care of that. It shouldn't just be that we pay for it," says Irwin.

The providers say regardless of what changes are made to the healthcare system, there are so many variables, it will be nearly impossible to predict what impact they will have until a few years down the road.

Senate Democrats unveiled a plan for reform, but Republicans say it's too costly.  A key vote on whether it moves forward is expected Saturday.  Earlier, the House passed its version which included a public option.  The sticking point between two measures is likely to be that public option and how to pay for reform.

Local health insurance providers will weigh in on the issue tomorrow evening on Newsline 9 at 6.

Online Reporter: Meg Bonacorsi