Health Care: Alaska's Challenge

What message does a one sentence paragraph starting with "and" actually send? What is the "important role" that consumers have? What protections would you establish to help prevent the rip off of medical consumers who have to travel to Anchorage, Fairbanks or Juneau to see a specialist? Would you ever consider an Ombudsman for medical consumers? Thank you. Terry J. Wolf

If you are elected what are your plans specifically regarding Certificate of Need in Alaska? Based on the FTC recommendation, the CON in Alaska should be removed. This recommendation comes after many studies have concluded that CON legislation restricts competition, which in turn increases prices. I work for Alaska Open Imaging Center and have seen first hand how hospitals have influenced legislation such as HB511 to ensure that they remain monopolies in this state. The intent of HB511 was to terminate the growth of Alaska Open Imaging Center into other areas of Alaska. Is this what we as Alaskan's want from our elected officials? Since opening in Wasilla 5 years ago, AOIC has forced the hospitals in Anchorage, Palmer, and Soldotna to replace outdated equipment and price their services competitively. I have had a firsthand view of how competition in imaging works. Now, new imaging centers in Fairbanks, South Anchorage, and Matsu are having to fight for their ability to stay open because of CON legislation. The department of Health and Social Services orginally deemed these facilities Physician owned and therefore not subject to CON applications. However, a judge in Fairbanks has overturned this decision. All of the above imaging centers are required to apply, and if the past is any indication of the future, to be denied a Certificate of Need. This will continue to decrease competition in these areas, driving up healthcare costs to consumers. This important piece of healthcare needs to be addressed in future debates. The people of Alaska have the right to know how each of the candidates stand on this issue.

Andrew's Response:

My position on the CON process are mentioned above. While in the legislature I saw the procss used as an anti-competitive tool to benefit big providers while squeezing out competition.

Mr. Halcro raises some fine points and I as a practicing health care provider have a few of my own. First of all health care cost will continue to rise and socialize medicine will never happen in this country. One must take matters into their own hands and modify their lifestyle and live healthier. That is the cheapest and best way to keep your health care cost down. Secondly we must hold insurance carriers responsible and insist that they pay for what they have promised to pay for. Health insurance is the only thing I can think of that I pay so much for and get so little in return. It seems like we're paying for piece of mind. The state of Alaska needs to hold the insurance carriers feet to the fire and tell them; If you're getting paid to cover an individual's health care then do it. We must also look at the Medicaid system and make some simple changes that will decrease the tax payer's burden and allow them to use those savings to help defray the cost of their own health care. First of all Medicaid users need to pay a nuisance or user fee when they use their health care. Not much but some. This will cut down on office charges when someone has a sniffle and goes straight to the doctor. Secondly there needs to be an emergency room fee that is higher than a clinic fee. This will help stop using the ER as their primary care facility. It is well known that ER fees are much higher than regular office fees. In my practice we charge approximately $55 to evaluate a sore throat. The ER will charge near $600 for the same problem. When we enable people to get seen at the ER for their primary care problems than we will pay more this health care by taxes. Diseases such as diabetes and heart disease are largely preventable. Smoking increases all health care risks. Why should the tax payer pay for someone abusing their body? Lastly we need to continue tort reform in the state. Several years ago I went to a conference and was told that the average physician age where I practiced was 55 years old with no projected growth. Many health care providers choose not to come to Alaska because malpractice premiums are too high. The physicians we have, especially specialist are over worked and charge too much. We need to make the state more attractive to health care providers so they will come here. More physicians will mean more access to health care and lower cost. If we don't address this issue, we're going to run very short of providers in the near future. Addressing some of these issues will help decrease the cost of health care. Addressing the abuses of the Medicaid system will help decrease the tax payer's burden. When you add it up, we're failing miserable addressing the health care concerns of this state. What say you Mr. Halcro?

Andrew's response:

All of your points are right on target. 

This country spends a significant portion of its gdp on health care. In fact, America spends more per capita on health care than any other developed country and still we have the most in-effecient system.

For the last five years, health care costs have continued to grow faster than the average wage increase. In a society that has been called the "sickest generation" this has had predictable outcomes. According to studies, the largest contributor to  bankruptcy today is due to debt associated with major medical illnesses.

In Alaska, it is estimated that roughly 110,000 Alaskans have no health coverage.

And while the biggest debate with health care is over who pays and should government get involved, the truth is that government is already involved and taxpayers are already paying for health care.

This year the cost of Medicare in the State's budget rose $104 million dollars for fy07. In total, Alaska spends over $1 billion a year on government health care services. These costs represent the primary cause of increased government budgets including the $6.9 biliion projected shortfall in the state employee retirement shortfall.

In addition, due to costs shifts, Alaska's hospitals are losing over $80 million a year on uncollectable charges from either un-insured or under insured. At the end of the day, the cost from those who can't pay is shifted to those who do pay.

When you consider all of these economic impacts and that health trends aren't turning at all (Diabetes up 27% in Alaska) we need to do something. As you stated, it has to be a comprehensive approach.

We need to focus more on prevention and education, lifestyle choices and promting healthy alternatives. One place to start is with school nutrition and getting back to regular physical education programs to address the growing probelm of child obesity. Money from candy and pop machines has become an important staple to allow schools to fund school activities.

Over the last few decades of boom and bust government, we've cut back on those key prevention strategies. And with tobacco being a major contributor to government health costs, instead of investing adequate funds from the tobacco settlement agreement into cessation to reduce future costs, we're using the revenue to pay for schools and roads

In addition, Alaska needs to improve access to care at the same time requiring patients pay a fair share. One of the biggest causes of  over/under utilization is the consumer dis-connect with health care payments. Many health care consumers aren't responsible for that first dollar expense, so they take no responsibilty in managing their care.

In turn, fewer and fewer physicians are taking Medicare patients because government re-imbursement levels don't cover the true cost of providing the service.

Health care is a complex issue but like many public policy challenges can be solved. The economic reality is that with costs far outpacing wage growth while crippling local and state budgets, we can't continue without structural changes.

With an aging demographic in Alaska, less employers offering coverage to their employees and an in-migration that will continue to drive government health costs, we need a plan.

I'll be formally presenting a complete health care strategy plan later this summer. Stay tuned and more importantly stay healthy.