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First step to fixing doc shortage is knowing root of problem

October 1, 2017 - 12:05am

Before we can possibly fix our problems, we must understand their cause. You recently reported on Hawaii’s problem with attracting and retaining an adequate number of doctors. The article pointed to the lack of money as a significant part of the problem, including Hawaii’s relatively low level of reimbursement for medical services compared to other states, considering our high cost of living.

We all love the idea of the government paying for our medical care. Our country moved significantly in that direction with the advent of Medicare and Medicaid during the Johnson administration. But a system where the consumer doesn’t pay for the product or service he receives can’t work. As a youth, I learned the saying: “He who pays the piper calls the tune.” If the payor can’t limit what he will pay, spending will skyrocket. This happened after Medicare and Medicaid were put in place. Patients no longer cared much about costs, and providers began raising their fees, as their customers (patients) weren’t bearing the burden. Hence, the government began limiting what it would pay for services. But if the program doesn’t pay enough to attract providers, there will be a shortage.

That is our fundamental problem in Hawaii. The federal government sets the price it will pay for Medicare/Medicaid services. Nationally, the amount paid is not adequate to cover the costs or attract providers, and commercial insurers and private payers make up the shortfall. Our problem in Hawaii is even worse, as payments here are not as high as those of other high cost-of-living areas, such as California. Payment levels were set in the early ‘70s for the various parts of the country based upon the fees charged in those areas at that time. Hawaii was not as high a cost-of-living place then as it is today. But we continue to be reimbursed at the level of lower cost-of-living locations in the Pacific like Guam.

Medicare/Medicaid currently covers almost two-thirds of the patients in our hospitals and a significant percentage of those treated by our physicians. If our country moves further into government-provided health care, we can expect the shortage of providers to become worse. Obamacare didn’t create this problem, but to the extent it expanded Medicaid coverage, it made it worse, as Medicaid is the poorest paying program. If we move toward “Medicare for all,” as some of our politicians are advocating, we can expect the situation to get worse. We’ll all have health insurance, but we won’t be able to find a doctor, and keeping our hospital doors open will become even more difficult. In the end, we’ll have concierge medicine for those who pay for their own services, and long wait times for the rest of us.

Finding a solution will be difficult, but recognizing the cause must be the first step.

Bill Hastings is a Waimea resident and member of the North Hawaii Community Hospital Board.

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