By Rob Ollikainen
Peninsula Daily News
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On one hand, the 2,400-page Patient Protection and Affordable Care Act that President Barack Obama signed in March does a good job of fixing health insurance and improving access to health care, Olympic Medical Center Chief Executive Officer Eric Lewis said.
On the other hand, it falls short in improving quality and controlling costs, Lewis told the League of Women Voters of Clallam County on Tuesday in Port Angeles.
"I view this law as the beginning of reform, not the end," Lewis told an audience of more than 100 in a two-hour meeting at OMC's Port Angeles hospital.
"We have a lot of work to do to control costs, improve quality and make sure the local health care system stays economically viable."
The League of Women Voters of Clallam County hosted the meeting called "How the New Health Care Bill Affects You."
The partisan-line federal legislation is a hodgepodge of insurance regulations, taxes, fees and mandates for employers and individuals. Most of it takes effect in 2014.
The panel was comprised of Dr. Tom Locke, public health officer for Clallam and Jefferson counties, Lewis and Dr. Don Mitchell, who chairs the Western Washington chapter of Physicians for a National Health Program.
"This is a modest, positive beginning investment for public health services," Locke said.
"It's a first step in a long journey, but it's a journey we've got to take."
The panel agreed that the status quo was not sustainable.
Lewis said the new law will insure another 32 million Americans -- and 5,000 to 6,000 in Clallam County -- by the end of the decade.
"Right now, we have [9,000] or 10,000 uninsured people that are residents in Clallam County, and a good chunk of them will become insured," Lewis said.
"I think there will still be quite a few uninsured people and the need for our free clinics such as VIMO [Volunteers in Medicine of the Olympics] will still be fairly large."
Lewis said his biggest disappointment with the law is that it doesn't change the delivery system enough.
"We need to change to a system that's focused on prevention, chronic disease management and primary care," Lewis said.
He said he hopes that provisions included in the law will improve compensation for primary care physicians.
"I think it's a start, and not necessarily solving the complete problem in primary care," Lewis said.
Locke wants a health care system that focuses on prevention and early detection before medical care. He said the U.S. ranks No. 1 in health care costs, obesity and hospitalizations for asthma and diabetes.
"The things we're No. 1, in almost all cases, are not good things to be No. 1 in," Locke said.
"There's no one in the same ballpark as us in terms of volume, complexity and cost for services.
"If we want to afford universal access, we have to get healthier as a country. If we get sicker and sicker, there's no way we can afford even what we're doing right now, much less expanding it for the population."
Mitchell would prefer universal health care, not just the 95 percent that the bill is supposed to cover by 2019.
"It's a start," Mitchell said of the bill.
"One of our major concerns is our current reliance on the for-profit private health insurance companies."
An audience member drew some applause by saying that doctors should stand up to the insurance companies. Lewis said the insurance companies and the pharmaceutical industry got a lot of what they wanted in the bill.
But Locke said the law stops the most egregious insurance practices, like denying coverage because of pre-existing conditions. He said it has some provisions and a $15 billion public health fund for the next 10 years that could help prevent diseases.
Before health care reform was passed, Lewis spent more than a year analyzing the legislation in the U.S. House and Senate.
He lobbied federal legislators to address geographic variation in Medicare. Geographic variation is the difference that Medicare pays per enrollee.
In Florida, for example, Medicare pays 50 percent more per patient per year than Washington state, yet Washington has better outcomes.
So in essence, Florida hospitals get paid twice as much as OMC, which relies heavily on Medicare and Medicaid, Lewis said.
"Clallam County is a very cost-effective, high quality area," Lewis said.
"We have low costs and good outcomes. Moving the money around more fairly was my goal.
"Congressman [Norm] Dicks did a great job getting it in the House bill. But health care reform finally passed the Senate bill and it [geographic variation] was not in the Senate bill."
Lewis said a big problem with Medicare is that it underpays doctors, particularly primary care physicians.
"Everybody remembers when Virginia Mason pulled out of town," he said.
"I think a lack of physician reimbursement was a big reason for that, and it's only gotten worse since 2006."
OMC stands to lose $26 million in Medicare payments over the next 10 years. After adding the $11.5 million in revenue for more insured patients, OMC will lose about $14 million this decade, Lewis said.
"That tells us that we have to become more efficient," he said. "We're certainly working on this now."
Reporter Rob Ollikainen can be reached at 360-417-3537 or at firstname.lastname@example.org.