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In Howard Co., Md., Public Option Finds Support



Now, a return visit to Howard County General Hospital in Columbia, Maryland. All year, we've been bouncing the Washington health care debate off people in that county. Doctors, patients, administrators, employers and insurance brokers in the Baltimore suburb have been our sounding board.

The other day, after the House had approved its version of a health care bill, I sat down with two people we heard from earlier this year. First, the CEO of the hospital, Vic Broccolino. For him, the measure of the health care problem is a crowded emergency room, people going to his hospital instead of to doctors. The prospect of a public insurance plan, which is so controversial in the Senate, strikes him as no problem.

M: For hospitals, a public option, provided it helps us to get us to the point where everyone is insured, is a good thing. We obviously like the idea that people are insured, will come to the hospital, we won't have to worry as much as we do now about bad debt and charity care.

I think that if the public option, however, ends up costing too much money and people, meaning businesses, end up dropping coverage because of that and they feel that it's better, perhaps, to pay the penalty rather than provide the coverage, that is not a good thing for the general public.

SIEGEL: If the public option were to be very expensive, you're saying that could be a problem.

M: Yes, that's correct. If it were expensive.

SIEGEL: I thought the insurance brokers were concerned that it could be very cheap, that it would undersell private insurance policies.

M: Well, if that's the case, then they will not be offering, in my mind, adequate coverage. Adequate coverage to me doesn't begin with hospital insurance or hospital coverage. It begins with primary care coverage because you can have everyone insured, but if no one has a physician to take care of them, the people end up in the hospitals' emergency department anyway.

SIEGEL: A big criticism of the bill, a criticism of another sort is that it would spread coverage to many millions of people who don't have health insurance, but it doesn't address the other problem we have, which is that as a country we spend too much money on health care. Do you see any cost-saving in the way we practice medicine in what's happening on Capitol Hill?

M: Well, if they can incorporate provisions in the final bill that actually penalize people for repeat admissions, people meaning physicians and hospitals for unnecessary repeat admissions, for inappropriate care, for not using evidence-based practice, for not coordinating the care between primary care physicians and the specialist, then I think there'll be some hope for savings.

SIEGEL: Mr. Broccolino, thank you very much for talking with us once again.

M: Thank you. Always good to see you.

SIEGEL: Vic Broccolino is the president and CEO of Howard County General Hospital. Mark Applestein is a urologist, and he's president of the hospital's professional staff. The public option doesn't faze Dr. Applestein either. He says public plans typically have lower overheads than private insurers. And like many physicians, what makes all these pills, bitter and otherwise, easier to swallow for Mark Applestein is Washington's plan to avert scheduled reductions in Medicare reimbursements. Dr. Applestein says those cuts in Medicare rates would threaten the livelihoods of many doctors.

D: There's been some reports that Medicare reimbursement rates only cover approximately 65 percent of the office overhead. So, one could then say, every time you see a Medicare patient, you're losing 35 percent.

SIEGEL: So, explain this apparent contradiction, which is there's an interest in the entire effort to overhaul health care, to bend the curve of health care expenditure to get down this two or three trillion dollars a year that we spend on health care. But then we get to a nitty-gritty issue like what do doctors get paid for their treatment of a huge number of Americans on Medicare and the answer is we got to spend more.

D: It's a challenge.


SIEGEL: It may be a euphemism, Dr. Applestein.

D: Yes, there is certainly within the system waste and, unfortunately, fraud. I do not think, though, that physicians intentionally either waste health care dollars or commit fraud. But there are parts of the document that address those issues specifically and perhaps with new systems in place, that will save some health care dollars.

SIEGEL: You told me when I spoke to you first time that you'd been at an urologist convention in Chicago and somebody mentioned single-payer plan, something that hasn't been on the table in this entire discussion. And a huge number of urologists said, bring it on. It wasn't a wacky idea as far as your fellow urologists were concerned.

D: I think it's still a good idea. It would certainly eliminate a lot of paperwork. Part of the document that the House put forward, there's a line item in there that says that this bill will reduce the paperwork and make it easier to submit claims and to track care, et cetera, et cetera. What's interesting is that the bill itself is over 1,900 pages, which is longer than "War and Peace" or the "King James Bible."

SIEGEL: Think that was not done in the spirit of reducing paperwork, writing a 1,900-page bill.

D: Well, it's pretty difficult to get through. So, it's sort of like trying to save money, but increase reimbursements. It's a challenge.

SIEGEL: Dr. Applestein, thank you very much for talking with us once again.

D: Thank for having me back. Transcript provided by NPR, Copyright NPR.

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