Look at Other Health Care Costs

Judy Pavlak is all scared that a simple appeal of the Office of Health Care Access ruling, which removed the Winsted Health Center Foundation from the local Certificate of Need, will force our Health Center to close [Look Before You Leap, February 8]. If this happens, voters will respond—and Governor Rowland and OHCA Commissioner Gorman will lose, not us.

Judy worries about wasting money, but democracy costs money, and precious lives. Had she, her Ad Hoc Committee and Charlotte Hungerford and its 100-plus doctors told Commissioner Gorman to keep our Center on the Certificate of Need, there would be no reason to appeal, and no added legal costs now. Asking Gorman to take another look, as Judy insisted should have been done before a lawsuit was filed, would have cost as much as the appeal.

Judy wanted another walk-in clinic, but Dr. Grinspan said few doctors could afford to work at one, and opening one would mean less money for the emergency room. I think Judy attended that meeting of the Ad Hoc Committee.

I believe the Pavlaks have yet to tell us that at least one of their relatives works for Charlotte Hungerford—which is just fine with me, but I thought a "community watchdog" would have offered us that information.

Judy continues to insist that we look at the costs incurred by our small, fledgling Center, even as the Hartford Courant reports that "Anthem, Inc., which owns Blue Cross and Blue Shield health plans in eight states," made profits on the health care consumers in those states of $99 million in the last quarter of 2001, not counting costs of the company’s initial public offering. At about $100 million per quarter, that’s $400 million a year in profits Anthem gives stockholders—instead of spending that money on health care services for the patients of their HMO. And that’s just one HMO. Actual net income was $87.7 million for the last quarter of 2001—shortly after Anthem, as you recall, threw our elderly citizens off their HMO. Had it not been for Medicare, these people would be without any health insurance, just as some 50 million others are now. Do we hear our "community watchdog" Judy complaining about this state of affairs? Nope.

The Courant also reports on what I refer to as Anthem, Inc.’s administrative costs, saying "its medical loss ratio—the portion of every premium dollar that pays for medical care—rose to 82.7% in the 4th quarter, from 81.9% a year earlier." If we take 17.3% (the remainder after 82.7% goes to health services) as administrative costs for Anthem, this means Anthem spent over $600 million of its $3.6 billion quarterly revenues for something other than medical care. If Medicare ran Anthem, Inc. in the eight states where it operates, consumers of Anthem’s services might have saved some $446.5 million (an estimated difference between Anthem’s and Medicare’s administrative costs), or close to half a billion dollars—huge sums of money that should be used for health care services. Whither Judy Pavlak and Commissioner Gorman?

Governor Rowland’s budget request for OHCA is/was $5 million per year, but the General Assembly usually appropriates about $3.5 million. Charlotte reports that, for 1999, it cut administrative staff from 45 to 15, indicating their costs were too high. Expenses of our fledgling Health Center are miniscule in comparison to the huge profits of HMOs like Anthem, Inc., as well as to the millions of taxpayer dollars spent on OHCA annually—and, I’m sure, to the hundreds of thousands of dollars Charlotte is now saving, as it should, by reducing unneeded staff. Had OHCA been more on the stick regarding costs at Charlotte, there would have been no reason for the fear and trepidation caused by Charlotte’s threats to close our emergency room and other services, just as there is no reason to cause similar fears now.

In my opinion, Judy Pavlak’s continuing volleys at our Health Center undermine her own credibility as a community watchdog, especially as she ignores the billions of dollars expended for executive pay at corporate hospital chains and HMOs, or sent as "profits" to stockholders of these firms. Instead, we need to pay our doctors, nurses and health care providers better. We need to reopen our closed emergency rooms across America, and to reopen our hospitals. I believe Judy unfairly targets our fledgling Health Center while ignoring the major players in a game designed to deliver the most dollars to for-profit corporations—and politicians—who care less about your health or mine. She also ignores the fact that even OHCA failed to identify and financially profile Connecticut hospitals that were in trouble before drastic action needed to be taken by Congress to avert further financial disaster for hospitals all over our country.

Ultimately, we are all to blame for the current crisis in health care as we continue to ignore the opportunist, profiteering, corporate influence over our health care, health insurance, political systems and individual lives. If our health care costs are to be affordable, and the quantity and quality of our health care services are to expand, Judy and the rest of us need to get together and start complaining to, and appealing from, those in state and federal government who can and should be leading in directions that we need to be going.