Civic Dialogue; Health Care Crisis

You tons have access to some of the best and most advanced medical treatment in the world. We also lack some of the most basic health care needs including immunizations prenatal and preventive care for our children. This sad discrepancy affects all of us but we have all played a part in getting our health care system to this crisis stage doctors practice defensive medicine out of fear that their patients may sue insurance companies must charge individuals and employers more. And no one knows where the soaring costs and blaming of each other will land somewhere in this maze of money and red tape. Are some solutions. We'll look for those solutions and at the future of our health care system. Tonight on civic dialogue. Good evening I'm Ted Kapler thank you for joining us. Perhaps nothing occupies the

minds of most Americans as does health care. The costs the availability and the quality. About one hundred fifty thousand Utahns in fact have no health insurance for those who do. Costs continue to skyrocket. New medical technology has brought new demands and new expectations and rapidly increasing cost. Government red tape and the threat of malpractise suits has added enormously to administrative costs. And in this election year candidates from those seeking the U.S. presidency to those seeking seats in the Utah state legislator legislature are espousing ways of dealing with the health care crisis. Should hope for solutions be sought at the national level or by the states. Can health care costs be contained at any level. Well we're coming to you tonight from the auditorium of the LDS hospital in Salt Lake City where we are joined by an audience of health care providers and others interested in

solutions to this most critical issue. And our panel of experts includes the president of the Utah Medical Association Dr. Quentin Harris also here is state Senator John Holmgren the chairman of the access to health care committee for the Utah State Senate. Also here is Mr. Don Omer. He is president of the Utah Health Insurance Association. Also here is Mr. Rick canners Lee. He is president and CEO of the Utah Hospital Association. Also here is Ms Penny brook. She is a nurse and an attorney and is assistant dean of the College of Nursing at the University of Utah. And finally Mr. Bill Walsh is here he is director of Utah issues. Mr. Walsh let me start with you. You represent the average man is that how you would define your position here fairly much more specifically low income people

special needs population. Well then they hopefully aren't the average person. Hopefully not. Would you say as we begin this discussion that health care is in fact a right for all Americans. Yes I would. I think health care need is becoming and needs to be seen more in the light of public education as a right. We as a society have said it is in our interest to. Providing education for all children. I think I'm hope we're moving forward in rapidly towards a day when we'll say we need to provide health care to all our citizens because it's it's in and it's in our interest and society's interest. Mr. Burke you are as I indicated both a nurse and an attorney. Would you say that in your opinion health care is a right for all Americans of all races creeds a socio economic classes.

I believe at the present time that health care is more of a privilege in our society than am I right. So legally speaking perhaps we're moving towards the time when we will legislate or or identify healthcare as a right but I believe presently it is more of a popular opinion that our society owes us rather than quote right in the legal sense. Dr. Harris you have to deal with with the issue of life and death in your medical practice. Isn't everyone in your opinion entitled to to live if they can and live in a healthy state. The medical profession has always felt that anyone who was ill had a right to receive medical care. We felt this long before we had insurance coverage or long before we had a Medicare Medicaid and the physicians of the state of Utah I feel have always had that same feeling.

But how can we afford to care for everyone whatever their need as what with the high costs of medical treatment now as we indicated the new technology and the fact that many people have no insurance. I think if we analyze where the money is going we'll find plenty of opportunities to provide good medical care if we can eliminate some of these drains on the on the money. What are some of those will come back to them but how would you define them now. Well as I analyze what's happened over the last 10 to 15 years I find an awful lot of people that are on the on the payroll of quote health care health care either providers or in some way involved that we didn't have years ago. For example in just to run an office you've got to have so many employees just to keep up with all the regulations and mandates that we keep getting And not only that but there have been in vain sions there have been technologies

that have been developed and skilled people have to run them. If you look at the overall situation going on in this country today you find that everybody's in a depression except the health care industry. And when you analyze what's happening in that industry you find that more and more jobs are becoming available. All we've got to do is to stop filling these jobs because they require salaries and money. OK. Does anyone care to disagree with the doctor Mr. Cain or say you represent hospitals. Do you concur that hospitals for whatever reasons are in fact hiring more and more people some of whom may not even be necessary. We certainly are hiring more and more people and we find with the hospital business and certainly in health care it's probably the only industry that we have that does not respond in the typical way that is as we add new technology in health

care. We do not reduce labor costs as we do so often in other sectors of the private economy. Health care is one sector where when. When we add new technology we usually always add additional labor costs. And thats being reflected in the burden that were carrying this part of our health care system. What about when we add new beds as they're called in hospitals or the construction of actual new buildings that when all of the hospitals we now have aren't filled the capital cost certainly are a major part of the system but we're very fortunate in Utah to have the fewest number of hospital beds per 10000 population of any state in the nation. So as we had as we address the issue of cost and we expressed concerns in that regard certainly we've got to find more efficient use of our capital investments but we're not dealing with near the size a problem as many other parts of the country are. But you're saying we don't have too many hospital beds to do say that. No I didn't say we don't have too many hospital beds but what we what we tend to focus on are

licensed hospital beds and that's a. A definition that's long since become obsolete because that was a definition that grew out of regulation and a need that the government established to have a certificate of need what we like in hospitals now is is utilized beds and when we look at our utilized beds we are running at a very efficient rate. They certificate of need which must needs be obtained in the past in Utah and it is still the case in some states doesn't exist here. Senator Holmgren should there be a section of legislation. I never favored the certificate of Neda and the reason for that is that competition should generally be able to handle that. The problem with that is as to why the add real competition out there that's that's the challenge you run into as far as determining where the needs are Dave get a name zero. I think our prisons in the long term care industry. We were able to

control beds in the long term care industry because 70 percent of the funding for those beds comes through are government programs and basically they were instructed that if they'd like to build a new long term care facility that's fine but we would put all patients in it and we have the beds are filled and we will have to do that through the control there. I think there is a danger of getting too many hospital beds I know there are some real concerns with those of us are involved now of the new facility that FHB is building out in the south or as part of their area here. No question they can demonstrate a need for that in their their particular business. Are there too many don't have the rights to do that are there too many long term care facilities in the state at the present time not at the present time there isn't a big sack there's in certain areas now that are being encouraged to expand their facilities to cover the needs. Mr. Omer we haven't heard from you on the issue of too much administrative cost too much overhead. Dr. Harris said

that that's one of the critical reasons for the skyrocketing costs that we've experienced these past few decades. Can I answer your first question first. Sure answer anyone you want for all of the about all you have OK. I think it is my judgment that whether it's a legal right it is a moral right of all our citizens to have a proper health care. But I follow that quickly by making certain that I'd say that needs to be identified. What is what is the health care that should be provided to them. Does that mean that everybody has the ability to take advantage of the latest technology for as long as it's required. Or does it mean that they have the right to a basic health care plan which will provide them with the necessities and what are those incessant need and what is it making basic health care plan. When I think that's a that's a significant thing for us to say once we've said the right is there

then that is to distinguish then what are the specifics of that ride here otherwise we won't have enough resources. You want to do that for us tell us what the right should be. Are your rights know I'd like to buy your next question. No it's to my current needs are your rights greater than mine are pennies greater than yours they may well be my rights may be dependent upon how old I am. I know how old you are went to school because I want to. Heart attack it made it just a header just on my lap on my situation. I think Harper were smart enough to be able to sit down and determine what is a basic health care plan which we can find and given we can determine how much we want to put into that what is a basic health care plan that everybody should have the advantages of going and being secure about. Then we can decide should be much of that should be provided by society and what should be right by

me. OK and lamp are right you've let me into my next question. The one I could have started with and didn't and that is who is going to decide what those basic rights should be. Should it be Senator home grown speaker Moti from home will hear shortly I'm sure the governor the federal Congress who should decide you as an insurer. As much respect as I have for the first two you mention I don't think they need to be. They should be the ones to decide and I don't think I should be. But the problem the enemy is us and we're the ones to make that decision. I do believe it's possible for us to identify individuals who can represent society and to make recommendations to such people as Mr Moody in this interview. Along with that and many places places that the committee has met this past year on access to health care. This was one of their concluding

assignments and they did complete that and they reviewed many basic health plans that are out there I think the American Medical Association has run that's very conservative. But they went through and they are made a basic recommendation that the committee the new committee when it's warm now will begin to work with. An actuary we'll see whether we can can afford it or not you know are gonna get the expertise to see if you can afford this right level of basic health care. Can you really get involved in that. You just can't have everything in your body like in that area. Well are you telling me that you think states should resolve this rather than a national health care plan. Universal health insurance. Socialized medicine in the olden days. That's not used anymore I don't think the federal government is in a position right now to really respond to this particular issue in a manner that will be timely. They have they're too far apart in their issues as they've presented them

politically but I think the states and several 14 states in the last year been working very different very hard on this issue. And I think you will see service out of there eventually a plan that will provide basic health care for Americans. Dr. Harris how do you feel about all this do you think the states can in fact come up with the number one enough money number to enough wisdom. Number three an outgrowth of the first to a plan to in fact resolve the issue to get basic. Human rights if you will to all Utahns or should it be done for the nation as a whole at the national level. Well I don't think the nation is ready to do this I think the state is. I think the physicians in the state of Utah are certainly willing and are already participating in this both with Senator Holmgren's plan but also on our own level in our own planning. We are trying to develop what we think are good

guidelines that we could present to the public and let the public then sift this and decide what they want to pay for. We don't need to get into the economics of it but we do need to get into what's good medical care the quality of the medical care that is provided in any basic plan has to be decided by the physician. And we feel we need to have that input and we're ready to do that. Who's going to decide the economics what about the state Mr. Omer and your insurance company and other insurers in the state. Well I got down on the side of the state the logical area to make those decisions come to those conclusions. However I'd also supposed to interject that we can't do that without some assistance help from the federal government. Medicare and Medicaid are too much a part of our program right now and they need to be involved in that too although they should not be the one developing

it and funding it and being in control. We have with us as I indicated earlier House speaker Krech Modi who hopes to go to the U.S. Congress. How do you scum down now on this issue as a state legislator hoping to become a. Congressman should have been solved at the state or the federal government. I would certainly say the state I think the state's much further ahead in the discussion the dialogue and much closer to the people and those that are necessary to really bring solution. I look at Medicaid Medicare and some of the problems we have there and that's certainly not something I think we want to emulate when we put together state programs so I think the states the real solution to it. And how much would taxes have to be increased to insure all the uninsured in Utah to give basic underpinnings if you will to do health care. Well that's really what that committee that task force Committee Senator Holmgren has referred to is really looking into and I think part of that in the surance companies this last legislative session talked about it

would cost about 1 percent to pick up 25 percent of those uninsured people. And so just by extending the age from age 21 day to 26 in terms of insurance companies and so we're on the track of looking for solutions certainly the panels up here have as many good ideas certainly legislators do but I think that's what this discussion is all about well but I don't know the price tag. Will there be there will be a price to it there will be an increase. There will be a price tag at some level the question is as it does that you know is that at the insurance level is that. As Dr. Harris indicated just taking the money and reallocating aware it can bring about the proper use of funds so that we can have the health care for people. Where does that take place and I think preventative care is an area we haven't talked about that it really needs to be part of this discussion as well. OK we'll get to that later. Let me point out that many small businesses in Utah do not provide health insurance for their employees. A recent KSL TV Deseret News poll indicated that 79 percent

of those asked said that they either strongly favored or somewhat favored requiring all businesses to offer health insurance for their employees or pay into a pool for universal health coverage now this is in the state of Utah This is in the nation and in the past two years there have been 23 states Senator own grim 23 states which have passed laws allowing or requiring insurers to offer low cost basic insurance plans to small employers. But Utah is not one of those states why not. I'm that's a figure that I have not heard before as chair of the committee I'm unaware that 23 states have required you're dong about a player play situation and that is not something that's been very widely accepted and I had a committee that I have been in that that really ships an undue burden to industry to provide that particular care and I'd I don't think that the people in the state of Utah would want to move in that particular Well I don't think this is a pay or play.

This is not this is legislation that would allow them it is a who's the insurance expert here Don is this a pay or play I just referred to. You'll have to read it to me again which I liked. When you mandate. That they will be covered in any and any business that's a play or play plan that this is from nation's business last week's issue says in the past two years 23 states have passed laws allowing or require yet I did insurers to offer low cost basic insurance plans to small and that's not a payer not now that is not a pay or play no it isn't it is you know did you guys in anything like okay and Rich is really basically you know it's just kind of a cop out in my estimation in those days because if you're not really are supplying anything well it's an hour you have to have some kind of basic bare bones coverage which then we look to employers and insurance companies to to offer as one of their options and I think 23 states have provided that and they've had a there's a variety of experience.

Some It's been virtually in significant numbers of good that something good with it. Yeah that's what the article said Miss Brooke that we're talking so about the general public as though we're all on an equal standing and we haven't mentioned the unanswerable and as we talk about a state wide plan and and deciding what the the masses would like that's what we have when we get to a state or a federal plan we have to talk about the the generalized needs but I think that really it's dangerous we get into ethical areas of do we value children. More greatly in the state than we do with the elderly. Do we pay for the transplants and all the technology that we're capable of providing. Some of the dilemmas that we're going to face are far more serious than this generalized discussion of. We we'd all have our needs met on the quay. There are some very basic and difficult ethical issues which you have just referred to which are being confronted more and more and will have to be. Is that what you

just told us. That's what I think when we talk about the state or the federal legislators discussing this for us it kind of frightens me because legislation is what's good for the greatest number but those individuals that are in greatest need sometimes are still the victims are the ones that suffer. Well how would you propose for instance dealing with 350000 uninsured. Not to mention the uninsured in the state of Utah. I wish I had the answer I think I would be. We would all be very relieved if we had easy answers but I do believe we need to address those hard questions and issues when we're talking about the generalized need. I think we are very aware of the UN insurable in the state and the health data committee in the in the state taskforce are all trying to to collect information to come up with solutions.

But that is why I brought the issue of government which it seems to me whether we like it or not most need solve this for us because they represent us as a group and the nurses aren't going to solve it the television people are going to solve it and the doctors aren't who disagrees with me. Tell me who you are and how you feel about stand up here and it's to your family who you are. My name is Ken Knight. And what's your job. I work for Sinclair oil. Why are you here. I was invited to be here I'm also on the board of the. Valley hospitals are icy. OK so you are a businessman. Yes. Involved in health care delivery. We've talked about giving adequate insurance to the uninsured. The small businesses in the 225 employee area are those who most often have no insurance. The average national insurance premium is thirty six hundred dollars per employee. You employ more than 25 people. How do you as a

businessman not to speak of you as a hospital board member or whatever. How do you feel about this issue who should solve it and where are we going to find the answer. I think that government has to step in and I think it's a problem that it's beyond individual reconciliation amongst the parties involved. I don't think it's a problem that business is going to solve. I think it's a problem that the society has to solve. And when you say there's 150000 uninsured that may very well be but those people are not. Going without medical attention there's an awful lot of free care being given in this state. People are being accepted at hospitals. They're not being turned away. It's true they're uninsured but that just means that they they receive uncompensated care. And so that's an issue and I think that society has to step forward and address this issue but the point you have to start and has been alluded to here is you have to first start with a definition of what expectations are. This country and this state cannot afford to

give unlimited medical care to every citizen. We're beyond that point it will break us as a nation it will break us as a state. So there has to be a definition of what we expect and what we're willing to pay for because someone has to pay for it. And there's a couple of other reasons I think we have to get that we have to get into. But but I think it's an easy copout to say we're going to require business to pay all of the insurance premiums because the business doesn't pay for anything the consumers of what the business produces pay for things. So I gather you do not concur agree in any way with the so called pay or play plan. Where employers mostly small employers must either play by requiring by providing insurance or pay a special tax that will allow the state to do so. I category with that I think that the problem's a lot broader than that I think it's a problem for all of society not selected businesses. And for a small business that has an uninsured uninsurable person or two it could very well break that business

that look the small employer is at high risk in this for them to be required to pay premiums those premiums being calculated on a very small pool of employees is unrealistic. It has to be a much broader base than that. Thank you. I'm glad I made you stand up. I'm going to turn to you because we're here you're our host and tell me who you are. I'm Steve Colbert I'm with him on health care. How do you feel about this. This issue of providing for the uninsured the uninsured HBOS in your opinion and with your experience are those in Utah who go without needed health care. I think for the most part and almost almost entirely those who need hospital care do receive it. Because we have a very active not for profit system in this state and those hospitals do take people respect of their ability to pay. I think the place where it breaks down is that the primary care level is people getting into the system and we have some good things that are happening in that regard. We've got indigent clinics we've got hospitals that provide it. We've got charities that provide

it. But I think there are still places where it breaks down in terms of people getting good primary care. And that's the point at which we need to get them before the before the illness has become so great and then it costs everybody a whole lot more may take care of Dr. Harris said the administrative costs are contributing enormously to this problem. Are you guilty of that. Well I think I think as an as a total industry we're guilty of it. I mean I think we have our hospitals deal with it and the doctors deal with it we have many many many many different forms and systems and sets of requirements and so forth that every provider has to go through as he encounters a specific patient and then has to sort out OK you know what who pays for that patient and how. And clearly we need to simplify that. Our Ministry of COS and there are major problems we're dealing with. And I think we're part of the problem. I think others are part of that problem. Health premiums have increased the past several years in insurance premiums. The rate of 20 percent a year or your costs on average in this

hospital from where we speak is increasing at that quickly. Our costs in our hospitals have gone up roughly 8 percent a year over the past several years. And so no that's not true of our cost. And if you take out the part that's actually a cost shift where we are passing on the parts of the bills that are not paid for by Medicaid in Medicare for instance it drops down to lower than 8 percent. So it is not an issue of hospital cost going up that much. It is an issue of our overall societal cost for health care going up that much. Part of it is the charity care part of it is the cautious thing of Medicare Medicaid part of it is the new technology which comes into various settings in this in the health care delivery system. I know that premiums are going up by that much for many although again in this state the average premiums at least for one group of insurers I know of went up roughly 12 percent for the last couple of years so we hear those big numbers and they're true of some clearly but they're not universally true and they're not as true in this state as they may be in some other places. So we have no problem. Oh

that's not true. We clearly have a problem and we need to wean. There are number there are numerous solutions that all of us need to be working on. But Utah if you look at Utah's hospital cost for instance compared with the rest of the nation we run roughly 25 percent lower than other states in the nation on a case by case comparison. So that doesn't mean we don't have problems here doesn't mean we don't have things we need to work on but we're much better off than many states trying to tackle same problems. Thank you. We haven't talked about too into great detail about the the overall reasons for the crisis if there is one. Dr. Harris is there a crisis. Is there a health care crisis saying there's a crisis in society and medicine is just part of that crisis. Or I want to ask you to elaborate on the crisis in society because that's probably the subject for another another discussion. No but it all deals and impacts on medical care because they wind up in the emergency were OK and then get shot as they get in an auto accident as they get on drugs

and get involved in that and and unwed mothers and the whole bit. I mean it's all part of impacting on health care. Mr. Connor is like we are having problems with the delivery of health care in the United States but it's important to point out that virtually every industrial nation is having problems with cost and or the delivery of health care. We're not unique. This is not a unique problem for the United States. We have unique problems and we have to address those problems. But we're not seeing the solution to our problems in other foreign countries. What we have to address as we talk about access we have to talk about cost because you cannot fix the access problem if you don't fix the cost problem. And what the hospitals are now saying in this country is that it's time to reform the system and the reform has to take place in the form of changing the incentives in the system. Right now we're behaving perfectly well to the incentives that are in the system and that is that we as

providers hospitals get paid on the basis of the services we provide the more services we provide the more we get paid. And so what we've got to do is to find a way to restructure those incentives and the hospitals of this country are proposing changes now to bring about that kind of drastic reform little changes in what incentive do I have if I'm a patient in this or any other hospital and I'm told to take two Tylenol if you will because I can't take aspirin to Tylenol and they charge me $10 a pill and and I don't care my insurance company is going to pay for it as I do are proper. You don't care because you are insured and somebody else is paying the bill. One of the things we've got to change in this system is you need to be paying part of the cost of that care so you become much more sensitive about the charges that providers are handing you. You've got to share more in the cost. How much should I share. You ought to share on the basis of your income. We ought to means test our

system even the very poor should pay something for their care. It may be 10 cents and maybe 50 cents for those of of our professional employees it may be 10 percent of their income. We've got to change the system so that the incentives fall back on the individuals. Mr. Omar do you want to do that with your insurance company. Well I think many insurance companies and employers have done that. But by the way that's not up to anybody except in the employer right. That's that's really the thing I mean OK now aren't one when one talks about what insurance companies do for the most part what they do is what the employers who employ those insurance companies tell them to do. We provide a contract with them for them and some recommendations but the benefit schedule what's reimbursed how much of the premium is paid for by the employer and how much by the employee what the co-payments are argue determined and approved by the employer.

But isn't Dr. Harris going to be more anxious to care for Tom Smith if in fact he knows he's going to get 100 percent from you the insurer rather than having to get 25 percent from Tom Smith. He certainly is and that's one of the things that insurance companies need to make very clear to employers. That's our responsibility perhaps it's one we have not fulfilled too well. Mr. Walsh we have been told by Mr. Cantors Lee that as compared with other countries he didn't cite that anybody could I'm sure that we are in good shape. You represent you tell us a few minutes ago those who aren't in such good shape. Do you agree with all you've been hearing around here. Not quite now. I'm reminded by Bud Scruggs likes to quote Winston Churchill in saying that and I can always trust the Americans to do the right thing but only after they've exhausted every possible alternative. I really think that the the major problem is access I would like to see us solve that first.

Yes we can go to emergency rooms but that's that's not the right kind of care that people need. I do think we could we could structure the care primary care needs to come first prenatal care those type of things are really. Are of a higher priority and I think we're quite capable of doing that as a society and we look to our legislature to help with that but there's got to be in my mind a much bigger role for government in the administration of these plans in simplifying access all the way around. And and I would I think it ought to be paid for by all of us I mean we're all going to have to hurt a little bit before things get better. Have you heard or seen or read any plans presented by the national candidates for the presidency that attract you you said it must needs to be done by government. I'm assuming it could be at the national level in your opinion or at the state level.

Well I think I I liked what Bob Kerrey had to say I was on some national plan but I think here in Utah we it is make more manageable I think we have we can get the leadership here to step forth in and and and solve our problems to a much larger degree. But I I think the sharing of the cost is going to it's going to cost something and that's only logical. But I think we're going to have to spread that cost around not just the businesses not just the. Consumer side it's got to be spread around and I think we're capable of doing it. OK. Tell me who you are and what your question or company. Ted my name is Kevin bish off I'm with Blue Cross Blue Shield and this made a very interesting discussion tonight and I just want to point out one thing when we were talking about preventative care and keeping ourselves healthy last year in 1901 about seven percent of all the money that we brought in the Blue Cross Blue Shield went to overhead expenses 90 percent was paid out in claims. And that's where we can make a big difference is to reduce that 90 percent we were talking about overhead being

a major problem. But 90 percent of the money that we bring in in revenues is paid back out of medical claims. And I think that's where we can make the difference is if people simply have to go to the hospital or the doctor unless we're going to have to pay out less and it is ultimately going to make a big difference in our overall health care costs. But that's a very tough point to get across. OK good we appreciate that comment penny. But I think many people that are insured will not get reimbursed if they go to their family physician and meet him or her at the office on Sunday and they will they will be covered if they go to the emergency room. I've heard many friends many cohorts say I've tried to save my insurance company money doing this or that and therefore I'm not covered by it so unmet perhaps it's our employers that need to contract more wisely with the insurance companies but I do believe there are the mechanisms for reducing costs are not totally in place for the insured right now.

How many of your premium holders would you guess or maybe you know must pay a portion of any health care that they get and how many are 100 percent covered. I would say that almost all men will pay a certain portion and then it's something that we would certainly support either through deductibles or co-payments. Almost every plan we have now has that build into it. And I do think that that has slowed the utilization somewhat. But we still have to do more in that area. OK thank you. Mr. Brooke let me ask you because you are as we indicated both a legal mind and a health provider as a nurse and also an administrator. Have we gone too far in trying to care for people. Do we have too much technology. Can we afford all we have. Do we need to prioritize you mentioned this earlier about taking care of certain people. Should someone who is

7 day 65 whatever be capable should be given a heart transplant if they need one. This is where I do think the the ethics that we're all being confronted with are so severe and difficult. I I don't want to be the person to value life based on age or productivity or income. I believe that we are we're saying of a re-emergence of old diseases we thought were taking care of tuberculosis is joining in with HIV positive patients. We're saying even measles and communicable diseases rearing their ugly heads again. I believe that we have some basic health care issues that we can't ignore that in this society that that maybe we didn't have 10 years ago. But the increased technology I would never stop increasing technology. I believe that we all have what we all expect from the best of care that's possible and we all want to see continued

improvement. One thing I I do want to put in Ted I'm I believe US technology has increased and we're able to preserve life longer. I hope that the physician and the patient and the nurse and the members of the health care team that are most closely involved with this will be allowed to be the decision makers and that we won't pass that responsibility on to legislators or other people I think these hard decisions need to remain with the people that have to live with the decisions that are being made. And so I I don't think we can send all the difficult problems to the courts or to the legislature. One could argue as some people have and do I'm sure that that in a city the size of Salt Lake City for example that we have too many not only hospital beds which we talked about earlier but too many MRI machines if you will. How do you feel about that.

I believe the quality of care at our state is just superior Where are so. Fortunate to have the resources we have in Utah I don't think many consumers realize really just the outstanding quality of care we enjoy here. I was not intimately involved with the certificate of need program but this is where I believe that program would have saved healthcare consumers some cost by not having every facility have to have the same equipment to avoid and I trust accusations that we could get into that but let's not get into that right now the anti trust issue on the issue of very good health care. I think we would concur along the Wasatch Front but as we will see in this is a plug for camber Daria's program tomorrow night here on Channel 7. We will see it and see that in some of the rural areas of our state and other Western states that the health delivery system is not good and we won't discuss

that now but you can watch tomorrow night what it is 8 o'clock or 9 o'clock tomorrow night at 9 Tell me who you are. I'm Ted Evans. I'm a pediatrician. I'm going to those primary care guys. Do three things have come to my mind first of all what I see in my practice is just very very unrealistic expectations ranging from the teenager on drugs who expects that problem his behavior is going to be completely handled by somebody else to the teenager who gets pregnant too. The young mother or any mother who thinks that babies don't cry and there should be a medicine to make babies not cry. And right on up the line always to expect that there's instant gratification for all kinds of medical problems it's the it you can have your suit pressed in Back to you an hour and you can have a hamburger in 15 seconds and you can have a pizza in 15 minutes and that concept is instant available gratification and satisfaction of medical needs is just completely unrealistic. The idea that you have to have them

participate in the cost in a way that cost is waiting or whether it's paying or whether it's not having it available is something that I think is absolutely has to happen in our culture it's it's not insurance it's not doctors it's not lawyers it's the culture that expects instant sort of thing. The absolute final kind of thing was said and I wish I knew who said it wasn't Churchill but it was some bright British person that said the American looks on death as an option. And we get to the very end of our lives where we spend something I half of all our medical costs in the last 30 days of our life we treat death as though it were an option and it will pay a hundred thousand there two hundred thousand dollars to stand off death which just sucks away so much of the resources that we have and that can be explained in other ways. Some premies the area I'm in some premies may be just too expensive for us to TRA struggle to save. But who's going to decide that we as a culture AFA decide that we have to make the hard decisions.

Politicians help us facts and pain and medical costs and and all those things help us but I don't know the answer how we. Well there is no answer. Stay there I want to ask you something else. As a lawyer you're now this issue of who's going to decide that the parents of the young baby what was her name in the news the other day What was her name the young baby years. Why do I said yes to baby Teresa baby Teresa. How could one forget baby Theresa. The parents wanted to pull the plug and and the court wouldn't let him. And by the time the plug was pulled the tissues and organs were not of any value for transfer from a legal point of view. Did the court rule correctly or what the court was following the laws of their state and I believe the judge stated that she was as frustrated that she was that she was having to apply the laws as she interpreted them as the our news media later covered. We probably would face the

same dilemmas aid in this state. That's right we were we would. How do you feel about that. It's a terrible problem but I think that that has to be well out from the community and things have change in the community. There's lots of changes in attitudes that come over a period of time in the 30 years I've been practicing for instance child with Down's syndrome were hidden away in closets and not even help and now the whole attitude is to help people. But I think our culture can respond to this and is responding to it but I think pain has to be applied at times before people learn. Well I think you brought up a very significant issue Mr. Walsh wants to respond to and I can this I can tell but the issue of at the root of this and other problems is individual decision making is individual responsibility as Dr. Harris said earlier. But having said that the millennium isn't Hare we don't know you know about all of that when this will happen how do we solve it at the present time you say to inflict pain. Well I'm not talking about actual physical pain but the distress of having to make

these decisions. And I would say even though I'm surrounded by some of my lawyer friends without having to suffer that fear that whatever decision you make may be criticized either direction and being legally punished for it. Those are problems. Thank you. Thank you Mr. Walsh. Oh I I think the doctor has some some very legitimate points I would I would actually concur with most of what he said here. OK I want to say that the tear code blew the story about rural health care is on at 9 o'clock tomorrow night here on Channel 7. Well we've got just a few minutes left about 10 minutes left. We've talked about who should solve the problem we haven't answered it. We've come up with some possibilities. Dr. Harris You talked earlier about cultural difficulties I guess you'd call them difficulties cultural conditions which have a contribution and attribute it to to this whole situation. But what is what

is the resolution what is the way of solving all this other than cutting administrative costs. Well administrative costs are important because they're 25 percent of the total bill. OK. The liability costs are another 25 percent plus defensive medicine. But I think I would suggest this I think everybody in this room want to get together in the room and lock the door. And come up with some answers and I think that's what's not happening. Everybody is doing their thing and they're gaining because of what they're doing. And I think everybody has to give something to make it work. Well not only in this room but in this country. Right. Right. You know Miss Brooke we have to be ready and willing to make some changes in our basic provider system also I know nurse practitioners are an option that are not as widely utilized in our society or our state as they possibly could that we need to give up turf

and and not compete with one another but to to utilize new developing services to the best of their abilities also. Doctor a set that 25 percent of the of the costs of health care now are to protect against malpractise suits. That figure seems high to me and sat there for not your I wouldn't know if the figure is exacting up but I don't believe that lawyers on responsibility for that if it is I believe consumers have become very eager to. Find somebody to represent them if they believe they have been legally harmed someway so it's the consumers it's the insurance companies everybody involved needs to do their part to lower that amount if that is so. Well Mr. ROEMER Well I think that that 25 percent figure may not be too high when one understands that physicians and other providers tend to do things they would not ordinarily do all if or not this here behind

them right of the defensive medicine that's clear today and that's what you're referring to doctor as well you know in defensive medicine including the threat of malpractise suits creates an additional 25 I would think that that sounds accurate according to what I've read and you would know it. Senator home life under your own in your own time anybody you need to look at the positive aspect of this from you dolls or you know we do have a problem and I want to do is right Matt anyway but you have to realize that about 85 percent of our people have insurance. You dollars really burgeoned it right now because because of the baby a baby program and others are. Mark hourly rate for children is no one's problem. Probably in the nation right now we're really way down as far as deaths are concerned. We're saving more. More critical babies and that's where our problems

are with our defenses. I pulled the plug on that I don't know if you did maybe grandpa but how do you put it on the belt. You know that's tough because you don't know what technology is going to bring next year youngsters that 10 years ago would have passed away now become natural normalise because of our technology. I don't know where you you stop that but we are doing some very positive things in the state of Utah and I think we're going the right direction and I look around the country and I visit we've got the expertise right here in Utah I think to solve this problem. Oh it's got to get them together. Well we'll watch you in the next session of the legislature. We're going to do it. It's a state senator John home gran'pa Republican a box elder County right. Right thank you. Tell me who write him tell me I'm a practicing attorney representing hospitals I was going to ask Rick Kenner silly questions but in the interest of time I make to have time go ahead and then make a comment. I'll make my comment then ask a question today with regard to the issue of pulling the plug on

terminal patients my practical experience indicates in Utah that it's a much easier decision than the baby Teresa case you were talking about because our law is fairly clear about. Two physician certifying and the family making decisions and that can be implemented at great cost savings to allow death with dignity. My question is on another subject for Mr. generously. According to his hospital fax from 1990 in Utah the average length of stay for Utah patients were five point four days compared with seven point today's national average. Now how do we accomplish that in Utah and how does that affect cost savings in the health care system. I think the real credit for that statistic goes to the physicians. It's the way our physicians choose to practice medicine. And as Mr. Koehler mentioned we're now seeing studies we've seen two studies that have come out in the last couple of months that say that Utah's hospital

costs rank among the lowest five states in the nation. The General Accounting Office released a report that said Utah spends less on health care than almost any state in the nation. And I think you have to give most of the credit for that to the physicians and how they practice medicine. What we've got to do is find ways and we can find ways in the state of Utah. We don't have to look to the federal government to resolve a lot of our problems. We can reduce administrative costs right here in the state of Utah. We can do something about providing better access to insurance right here in the state of Utah. We can do something about tort reform and malpractise reform right here in the state of Utah. We don't have to look to the federal government to resolve those problems for us. The fact is the federal government is not going to take over this health care system and run of that less cost or more efficiently. We've got to find a way to run this system more efficiently ourselves. And you've got the folks here in the room today that are capable of doing that. OK Mr. Kenner's Lee knows we're coming to the end of the program and he's made a

and eloquent concluding statement. Now let me ask you as a lawyer would you favor legislation that would put limits on any malpractise suit to the settlements. From my perspective yes there are many lawyers who would disagree but I think malpractise suits have gone way out of lying far beyond the measurable damages to the patients. And I think limits are appropriate. Are there limits such limits in your time now do you know. No there are none you know. OK. Thank you. Thank you. Miss Brooks the comment I think we also need to get providers support to talk with their patients and follow the patient's desires and not live in fear that we're not going to stand behind what we say we will. If if the patient chooses to refuse treatment I think that's a basic problem as nobody wants to be the test case. And if there's a living surviving relative that can object to what the patient's chosen and the physician is

probably going to do with the living surviving possible plaintiff would want rather than the dying patient Dr. Harris. I would like to suggest along with Mr. Connerly that the solution to the problem is not socialization. We've seen disasters in socialized countries. Everyone has admitted it's been a chaos and health industry in those countries has been a disaster. If we wanted an answer we need to use the free enterprise system that we've got and we've got to get together as free enterprise people and come up with these solutions and I think we'll have a far better system than if we go to some nationalized system. Doctor you are president of the Utah Medical Association. I am a the American Medical Association which I suppose you're a delegate to. Has historically had the same position you're just espoused about any federal involvement in health care and yet the A.M.A. has changed dramatically in the last year or

two. To say that something must needs be done. Yes and we all agree with that. We can't go on the way we're doing this nation can't afford the cost of medical care that's going on right now. Now contributing to that cost I think is the fact that 87 percent of the physicians in America today are specialists and only 13 percent are what we used to call GP as are general practitioners and are now called Family Physicians. Do we need so many specialists that we've talked about. High expectations are high costs. Why don't we have more general practitioners family doctors. We go back to the incentives that were mentioned before we build into the system incentives not to be a primary practitioner. There is no incentive to go into medicine today as a matter of fact in the state of Utah. You'll find that primary care physicians are dropping out. They're going into corporate positions. They're leaving the state. They're disappearing and they're not even graduating in the medical

school into primary care specialties. This is what's happening because of incentives. Do we have too much specialization in your opinion. Nurses are having more specialization too all the time. Oh they are. I do believe when we end up having doctors broker patients to other specialists rather than being able to care holistically it does become more expensive. However I think in the case of nursing I believe nursing has a holistic approach and the nurse practitioner the midwife the pediatric specialist psychiatric specialist are trying to have more of a holistic approach to working with patients. OK Senator homegrown Mr. Kenner slay Dr. Harris Miss Brooke we'll take that as your closing statement we have 30 seconds. Mr. Walsh you want to give us your final analysis of what we've talked about here. I think our system is we're paying the institutions rather than the primary care as our priorities are not in line I think it's

part of that is because of we we've let competition roll. I think if we looked and tried to do the most good for the most people we would have a much restructured health care system. OK you did it in the allotted time Mr. Almer 30 seconds. Well just to reiterate that I believe cost is the driver and I don't believe that unless you do something about that you can solve the access or even the quality problem. That may mean incremental changes and trying to solve that rather than a change from the way we are the way we like to be. And we need to adjust our own expectations as to what can be accomplished over a period of time. Thank you gentlemen thank you very much and thanks to all of you and thanks to you for having been with us this evening. If you have a comment regarding tonight's broadcast please give us a call at 5:08 one day. We'll be back next week. I'm Ted Kapler. Good night. A.