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Health care from someone who ought to know

If it were easy, it would have already been done, and it would not have taken a year and more than 2,000 pages.

The Democrats are scared to pass it; the Republicans are licking their chops no matter what happens. The media is all over it, while the public is so sick of it, we’re really going to need a doctor!

What is it?

Health care reform.

It looks as if we are finally in the short rows of the process and, as the Andrae Crouch song title goes, “Soon and Very Soon” we may see the end of this debate or debacle, depending upon your view.

As that is the case, I thought it would be interesting to find out what someone who is actually in the health care industry thought about this complicated subject that affects every American.

Ron Gilliard has been in the business of hospital administration for almost 40 years. He’s a Mitchell County fellow and his guidance counselor in high school aroused his interest in this “new field” or endeavor back in the mid-1960s. He has enjoyed his work and, in hindsight, says the only thing he would do differently today would be to visit a psychologist before entering the field.

Ron is a retired lieutenant colonel in the Air Force and his experience is a combination of hospital administration in the Air Force and, since that retirement, in smaller hospitals in county seats much like Bainbridge. I have known him ever since those high school years, and I still remember him for the touchdown run he made to benefit his Mitchell County Panthers and break the hearts of my Pelham Hornets.

My first question to Ron was a basic one that goes to the heart of this health care question and many other questions that face American society today. Just who is responsible for us, in general, and for health care in particular? Is it the responsibility of the individual or a guaranteed civil right of the citizen?

“I personally feel health care is an individual responsibility and a privilege and not a right,” he answers. He bases his answer upon the Constitution. “No where in the Constitution does it say you get free health care.”

Ron is not callous in his feelings, though. He understands that his profession performs a necessary service and has to be compassionate and help those who cannot help themselves.

“This is a wonderful country and will always care for those that cannot pay for it, such as the disabled, veterans, etc.,” he says with pride, “but someone has to pay for those provisions. As my Daddy used to say, ‘someone has to pay the light bill.’” In other words, to Ron, health care must be viewed as a business and, for businesses to be successful, there must sustainability.

I wondered if hospitals, those rural and small hospitals that are so important to their communities, actually made money. He explained that they are not “for profit” entities, but that they cannot exist as money losers. A compassionate and caring staff must be paid. Expensive equipment is expected these days. Supplies are needed. And, apropos to our conversation, he said his staff’s health insurance premiums had risen by 30 percent in just this past year. As Daddy said, “Somebody has to pay.”

How is a hospital sustained money-wise? Is the greatest source of income from the patients? I was not surprised at the difficulty that hospitals face.

First off there are the losses that come from indigents who simply do not or cannot pay. That total can range anywhere from 10 to 14 percent in his hospital. That has to be made up and the only answer is to shift the cost from those who cannot to those who can. That’s why private insurance companies pay more. Ron doesn’t particularly like that or even think that it’s fair, but he admits that he doesn’t have another answer.

Well, what about Medicare and Medicaid? I have always wondered about their place in this health care equation. They are government programs and all of this reform talk seems to be leading to the government doing even more. Are they doing a good job now? If they are, then maybe reform will be good. If they are not, then, why would we be expanding their places?

His answer was interesting to me. “Medicare and Medicaid are not well run in my opinion and that is why I hope that reform does not lead to an expansion of both to cover those millions who are uninsured. I really don’t think Medicaid or Medicare can handle the extra workload.”

Another question that I have always wanted to know the answer to was posed. Just how much do Medicare and Medicaid pay? The answer is different for hospitals depending upon the designation. Ron’s hospital is a Critical Access Hospital and Medicare pays costs plus 1 percent. Medicaid pays about 85 percent of the cost. Those formulas carry nothing to a bottom line.

Therefore, hospitals must be very creative to create a positive balance sheet. They seek the support of communities through the encouragement of donations and individuals “adopting” rooms and areas. Auxiliaries and volunteers do wonderful work. Sometimes counties offer help through taxes. There are those instances where government grants and payments help with indigent expenses. Ron truly approaches his responsibility with diligence and pride, but never loses sight of the need for a positive bottom line.

I had a bottom line in mind also. Where do you stand, Ron, on health care reform?

You, who have been in the profession for almost 40 years, what do you think?

He begins with a practical statement worthy of a hospital administrator.

“Why would I not want reform if it were going to cover all those people now that have no insurance and don’t pay us for the care that we provide?”

Does that mean he would vote “yes” for this bill?

Not so fast.

“As a private citizen, I am very concerned how it is going to be paid for.” In other words, he thinks this bill is not the best approach. “I just don’t think that the federal government can take on any more and I think your and my taxes will go up and we may still have problems.”

OK, what to do?

“Reforms in many areas are needed, but not from the government,” he says. “America is and has always been built on private initiative and innovative approaches. Exchanges may be good, as well as some tax credits for policies to get the patient involved in taking better care of his own health and that of his family. Get back to individual responsibility. Tort reform is another area. I believe a more patient and incremental approach would be more successful and have greater support.”

My e-mail conversation with Ron was very instructive. I appreciate him taking the time to give me a view from someone who knows more about health care than I do. I wonder if our politicians in Washington have bothered to talk with people like him.