Consider Another Way to Deliver Healthcare than Public Clinic

June 16, 2005 8:51PM

By Dr. Robert S. Berry Over the next few weeks, approximately 226,000 individuals will receive a TennCare disenrollment letter notifying them that they will soon join the over 500,000 Tennesseans who are already uninsured. Over the next few weeks, approximately 226,000 individuals will receive a TennCare disenrollment letter notifying them that they will soon join the over 500,000 Tennesseans who are already uninsured. As a Tennessee primary care physician with roughly 3,500 uninsured in a 6,000-patient practice, I have attended more than 15,000 office visits by uninsured patients since we opened in 2001. Our clinic drastically reduces the cost of health care to patients by accepting no third-party payment and requesting payment at the time of service. Believing that this kind of frontline experience might prove useful to the governor’s Task Force on the Health-Care Safety Net, I attended its first public forum in early March. I described how our clinic offers timely medical services at about one-third the price of area urgent care facilities and one-tenth the price of area ER’s without receiving public support either directly in the form of government grants or indirectly through nonprofit incorporation. This cost savings translates into fees that are little more than the $32 office co-payment the governor’s consulting group McKinsey & Co. recommended for “able-bodied” TennCare recipients. Gov. Phil Bredesen initially agreed with the recommendation saying, “The only way you manage utilization effectively is to have some economic skin in the game at the point-of-sale.” As a candidate, Bredesen promised to fix TennCare using a common sense, business approach. As governor, however, Bredesen has retreated from bolstering individual choice and responsibility as a way of controlling cost. None of the 10 health-care professionals he selected to serve on the TennCare Task Force represent the growing number of insurance-free medical practices that, like us, have already been providing a safety net for the uninsured. Few on the task force personally take care of uninsured patients. Not surprisingly, the task force recommended a tangle of bureaucratic options. Bredesen seems to have more confidence in state solutions to our health-care problems than he does in private ones, such as my clinic. But is his confidence well placed? Based on recent events, probably not. Former state Sen. John Ford allegedly received kickbacks from at least two large TennCare contractors, and Ford and three other legislators are currently under indictment for a bevy of federal corruption charges. With lawmakers like this, how can we trust that our politicians have the health-care needs of Tennesseans at heart? Even if legislators truly want what’s best for the uninsured individuals of this state, will adding facilities and personnel for routine health care at county health departments — as the task force suggested — be the best use of taxpayer money? This simply shifts money from private to public facilities with much of it being wasted in new construction and recruiting costs so that even less is available to care for patients. For Bredesen and his task force, applying taxpayer money to government health care is less about patient care than state control. Tennesseans don’t want more public health care. In the East Tennessee area where our clinic is based, discounted and free medical care is already available at the county health department and three nearby rural health consortium clinics. Still, over 3,500 uninsured patients and 500 TennCare recipients have chosen instead to pay out of their own pockets at our clinic rather than wait to see a nurse practitioner at one of these government facilities. Rather than encouraging further expansion of inefficient and ineffective government bureaucracy in everyday health care, the governor should hold true to his word and promote the growth of economic skin in the health care marketplace by fostering private solutions. Otherwise, it will be impossible for Tennessee to heal its ailing TennCare system.