Doctor’s Rx for What Ails Medi-Care : Health: An Anaheim physician who headed state Medical Assn. tells why he’s lobbying for a mandatory insurance law.
Dr. Charles W. Plows apologized for his cluttered desk, strewn with copies of draft legislation on medical issues.
The pile of papers has grown because he’s been out of town so often, the 68-year-old physician explained. For more than a year, Plows has spent part of every week touring California--speaking to Rotary Clubs and radio talk shows and regularly buttonholing legislators, seeking their votes on mandatory health insurance.
For Plows is no ordinary physician. The genial, white-haired gynecologist has spent the last year as president of the state’s leading medical lobby, the California Medical Assn.
Representing 38,000 physicians from San Diego to Yreka, Plows lobbied for swifter discipline for problem physicians. He worked for broader bans on cigarette smoking. He tried to educate the Legislature on the need for testing of an extraordinarily controversial drug, the French abortion pill, RU 486. And he lobbied tirelessly for legislation to create statewide health insurance.
Though Plows stepped down last month as CMA president, he will remain on the association’s executive board for another year and expects to continue stumping the state for CMA’s insurance plan--now planned as an initiative for the June, 1992 ballot.
In between lectures to doctors’ groups and civic clubs, Plows continues to see patients in a comfortable office near Martin Luther Hospital.
He genuinely likes practicing medicine, the doctor said with a smile. In 39 years of obstetrics and gynecology, he has delivered more than 6,000 babies--and he still thinks that’s one of the most wonderful things a doctor can do. But he has strong ideas about changes needed in medicine--health insurance chief among them--and he still has political work to do.
In an interview with The Times, Plows talked about some of the challenges facing the medical community in Orange County and the state, including the need for more indigent health care services, skyrocketing insurance rates and the response of the County Board of Supervisors to the health care crisis.
Question: How well do you think the Medi-Cal “network” is working for Orange County’s indigent patients? Orange County’s program used to have 17 Medi-Cal contract hospitals several years ago but now has only 10, with your hospital, Martin Luther, among the latest to quit. What do you think of this system now?
Answer: It’s getting pretty moth-eaten. The safety net is in shreds.
The patient is being forced into going long distances to access the hospital.
Doctors with the two largest Medi-Cal practices at Martin Luther Hospital are trying to transfer all their patients to Medical Center of Garden Grove. Well, that’s a bit of a shuffle for some.
But the hospitals really have to quit Medi-Cal. The contracting commission for the state has offered such low per diems to the hospitals that they just cannot make it. . . .
If it were left up to me, the commission would just open up the county to Medi-Cal patients and let them go back to the old system of any obstetrician can take his patient to the hospital that he works in.
Q: How likely is that?
A: I think it will happen--if we see one or two more Medi-Cal hospitals close down. When Martin Luther (quit Medi-Cal), they must have cut 150 mothers out of that institution and into someplace else. And I hope we don’t have some catastrophe--the unnecessary loss of a mother and a baby because of her inability to access the system.
Q: Do you think county supervisors do enough for health care?
A: No. I really think they are really trying. But I just feel that they have shirked their responsibility for the county’s obligation to take care of the indigent.
Q: Where can supervisors get the money?
A: They have the right to impose taxes. That’s allowed by the state. . . . But there’s been no effort in that behalf.
Q: Why should they care more about the indigent?Does the average citizen understand that when hospitals lose too much money on indigent care, they may be forced to close emergency rooms, cut back on services like trauma care?
A: I don’t think they’re aware of acuteness of the problems.
Someday we’re doing to dial 911 and there’s not going to be anybody there. People will be dying in the ambulances and not in the streets. That’s what will happen. They’ll just have no place to go. Those trauma centers will be open--but full.
Fountain Valley Regional (Hospital and) Medical Center is out of the trauma system. UCI in Orange and Western Medical Center in Santa Ana are still in. So there you are--if you have an accident, have it in the city of Orange or Santa Ana.
Q: Do county supervisors have a legal obligation to do more for health care?
A: I think there’s a legal obligation, but it’s never been legally enforced. . . .
As long as the truly indigent are using (UCI)Medical Center as their hospital, then I feel the county should come up with reimbursement for those fees--certainly at a rate that the hospital can see without going broke.
Also I think they should try to get more money from the state. Of course, that is like getting blood out of a turnip this year.
And I think we’re going to have to depend on a county-local hospital effort solve the problem . . . perhaps more setting up of satellite clinics, perhaps run by residents (doctors in special training)or by contracting physicians.
In Los Angeles County, working through the medical association, they have assigned indigent patients (to private doctors)and spread the risk on a very large number of cooperating physicians. Also, Los Angeles County assumes some of the malpractice risk so every doctor who takes care of the county-subsidized patient is an employee, temporarily, of the county.
We (local doctors)are starting to consider this. . . . But it’s sort of bogged down right now. You know, there’s been such reluctance in the physician community to cooperate with the Medi-Cal program.
The problem is not only reimbursement. It’s the red tape in Sacramento--the denials and the suspense files and what I think is trivia, almost calculated to keep funds from being dispersed by delays.
Q: Do you take Medi-Cal patients?
A: I’ve taken Medi-Cal patients since the program was first started. I just have always felt it’s part of a physician’s responsibility to take care of those who are less fortunate than others.
Q: What is your top priority for health care?
A: No. 1 is access to health care for the uninsured in California. Also access to care for those that are in under-funded government programs.
Q: Do you have a proposal?
A: The alternative we’re looking at is our Affordable Basic Care (health insurance) program. But it looks like the Legislature has its hands full this year--with reapportionment and . . . of course, the budget shortfall of, maybe, $12 billion. Which means the chance for any program is pretty slim. So we’re looking intently at (a ballot) initiative process for 1992.
Q: Could you briefly describe the Affordable Basic Care program?
A: It’s really an extension of the employer-mandated system which takes care of the insurance for probably 80% of the people at work. Employers with five or more employees would have to offer a basic benefit insurance plan. The employer would pay 75% of the premium, and the employee would pay 25%. Those employees with minimum-wage (jobs) would be subsidized through additional funding from the state and other revenue sources.
Q: Why are doctors so concerned about health insurance?
A: We’re talking about 5 (million)to 6 million Californians without insurance. Four million of those have jobs--but no insurance. So they use the emergency rooms for their primary physician. I think patients are getting care, but getting care in the most expensive surrounding there is.
Q: Why is this so expensive?
A: If the patient has a headache and they go to the emergency room, a physician may well know the patient had migraine headaches forever. But (with concern about malpractice suits) the physician has to order a CAT scan of the brain and all kinds of lab studies.
But under (Affordable Basic Care), there will be cost controls. The chronic over-utilizer will be scrutinized and the benefit package will not include some exotic things like lung transplants.
Q: What does the Orange County delegation think of this plan?
A: Assemblyman Ross Johnson (R-La Habra), the minority leader, is very concerned (about high costs for small business). Most of the Republican (legislators) from Orange County would probably vote (against Affordable Basic Care).
But we want to demonstrate that the hit on the small employer may not be as overpowering as they think. A lot of small employers do offer insurance. And polling has shown that the citizens of California are willing to pay between $75 and $100 extra a year on their taxes to pay for care.
