July 27, 2001

Commentary

Destroying Our Health Care System

By James Santiago Grisolía, MD

Across San Diego, hospitals are falling like dominos: Sharp-Cabrillo, Scripps-East County, Mission Bay, Harborview, Hillside, Vista Hill. Meanwhile, three major doctor groups have gone bankrupt (Family Health Network, Paradise Valley IPA, Palomar-Pomerado IPA) while Scripps Clinic was just rescued from bankruptcy by the ScrippsHealth system. At a time when medical science is opening up amazing new vistas of human health, the foundations of American medicine have been eaten away by a fatally flawed insurance system. The damage has spread further and faster in California, threatening health care for Latinos and Anglos, rich and poor, young and old.

Caught in a failing system, California physicians feel powerless and trapped. The California Medical Association has just released a survey of 2,300 physicians, in which 43% of those responding plan to leave medical practice in the next 3 years, while another 12% plan to reduce their time seeing patients. Some 58% of doctors have had trouble looking for new doctors to join their practices. While most doctors still get pleasure from seeing patients—67% in this survey—75% have become less satisfied with medical practice, and two-thirds advise their children not to go into medicine.

What's wrong? For-profit, managed care insurance companies promised to save money by early, preventive care, which would save the cost of treating neglected disease later, in the more severe stages. On the surface, this made sense...after all, polio shots are much cheaper than an iron lung. Unfortunately, managed care has only made tiny savings by true preventive care. The major "savings" of health care dollars by managed care come from denying care to patients and by cutting back payments to doctors, nurses and hospitals by 30%, pocketing at least half that as profits. Meanwhile, the cost of health insurance keeps soaring, and 23% of San Diegans are uninsured, living one heartbeat away from medical and financial catastrophe.

California, which leads the nation in managed care, now also leads in bankruptcies of doctor groups and hospitals. These "rolling medical blackouts" make it impossible for doctors and hospitals to invest in cutting-edge technology, sometimes leave patients stranded without a doctor, and are persuading the best-trained doctors to leave California to practice elsewhere.

There are already doctor shortages in primary care, orthopedics, neurology and some other specialties. Sonoma County has lost 10% of its doctors; San Diego and other counties are just beginning to collect statistics. While established doctors slowly think about leaving the state, young doctors are already picking other places to start their practice. This hurts the community by taking away the next generation of doctors: newly trained, idealistic, and (often) Latino.

Daily experience and research both show that bicultural, bilingual doctors deliver the most effective health care. Small details of history get lost through translators, and direct give-and-take improves the patient's chances of getting the right medicine, understanding why it's important, and actually taking the medicine. The Latino community needs more Spanish-speaking primary care and specialist doctors in San Diego, but these new doctors aren't coming.

What can we do to save health care in San Diego? Right now, at least 23% of San Diegans are uninsured, but 60% of San Diego's uninsured are Latino. Although 80% of our uninsured have jobs, they work in companies where insurance benefits aren't offered, a greater problem for Latinos. We need to redistribute the administrative fat in health insurance companies to cover the uninsured, and to pay enough to doctors, nurses and hospitals so that new health professionals will want to come here to practice.

SDCMS has proposed "The Prescription for Change," a new, consumer-oriented approach to health care, where people will own and control their own insurance plans instead of having the plans owned by their employers. To gather input and build on this plan, SDCMS has convened a blue ribbon task force of business and healthcare leaders, with upcoming community input via Town Hall meetings. Past SDCMS President Bob Hertzka will lead a similar consensus-building effort at the state level, giving consumers a voice in Sacramento to push for people-centered reform of managed care.

In the meantime, the Latino community should ask its employers and elected officials to think about how we can change health insurance together. San Diego must send a strong message to the state of California, gathering the muscle of the world's sixth largest economy to push for a people-focussed solution. We must radically change American health care in order to save it.

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