Congressman gets an earful from hospital officials

America's health care system cannot be fixed without government intervention, said Billings hospital officials meeting Monday with free-market advocate Rep. Denny Rehberg.

Rehberg, who spent six hours speaking with various Billings groups about health care reform, received an earful from St. Vincent Healthcare administrators, who said meaningful change required some government action, up to a government-run health plan to compete with for-profit insurers.

"I believe we're going to have to look at a public option because I don't see how we're going to get things done with-out it," said Maryann Reese, St. Vincent Healthcare's chief operating officer.

American health care doesn't operate in a free-market economy now, Reese said. There's no right of refusal. Hospitals treat patients with or without insurance. Large government health insurance programs like Medicare, Medicaid, Indian Health Service and the Children's Health Insurance Program play huge roles in medical costs and how patients are treated. Hospital officials estimated that 70 percent of patient care at St. Vincent involves some government program. Those programs will have to play roles in changing the way health care is delivered, officials said.

Without a public option, lawmakers at the very least will have to force private insurers to accept all comers.

"Basically the goal set forth is to cover 97 percent of those who remain in the uninsured ranks," said Jim Paquette, St. Vincent chief executive officer. "I don't think the public option is really the issue as long as we set up a system that eliminates the issue of pre-existing conditions. If you eliminate all of that so insurers are not either making money or saving money based on cherry picking, then I think we feel that levels the playing field."

Rehberg, Montana's lone member of the U.S. House, was unswayed, insisting that the marketplace can best solve problems with American health care. There might be inefficiencies in the heath care industry now, the Republican said, but government involvement would only make matters worse.

Rehberg has said he would support tax incentives for people to stay healthier, as well as allowing health insurance to be sold across state lines so bigger customer pools can be created.

"I just fundamentally believe it can be done under a free-market system," Rehberg said.

However for-profit health insurance companies won't improve the system on their own, said Dr. Walt Pete, St. Vincent Healthcare Board chairman.

"Their job is to deny coverage, deny payment and increase co-payments," Pete said.

"We're seeing that now and it's getting, worse and worse and worse. They're botching it," he said.

Hospitals identified key goals in the health care debate that they said couldn't be accomplished without government partnership. Lawmakers and medical officials alike say there's too much emphasis currently on paying doctors for the number of procedures they perform, rather than on the outcome of their care. There's no money for the kind of after-care that nips return hospital visits in the bud. Government health programs also pay by the procedure, and need to change.

There's also a push for more teamwork among doctors and hospitals treating the same patient. A more integrated approach is proposed to reduce costly treatment duplications and to give providers a comprehensive picture of a pa-tient's care.

But integrated management requires electronic medical records that can be read by all, which is currently impossible. Medical record systems of different vendors are as incompatible as operating systems for Apple and IBM computers once were.

Steve Ballock, St. Vincent's chief finance officer, said there really isn't time for a free market, last-company-standing solution to medical records if teamwork medicine is a goal. The government will have to establish a universal language for electronic medical records that all doctors can access.

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