National Health Care Reform

There is no question that medical costs are skyrocketing and reform is imperative. But your implication that the principal providers in the system--doctors and hospitals--are primarily the cause is too simplistic. Hospitals want meaningful reform that addresses all of the root causes.

What are the solutions? We have to start with affordable, accessible care for everyone, and that means coverage for the 6 million uninsured Californians. Reducing the rate of increase in a fairer, more equitable system with less duplication and waste is obviously a significant part of the answer. In order to contain costs, another equally significant solution lies in correcting the structural flaws in the current financing and delivery systems. In addition to changes in the insurance system to reduce administrative costs, meaningful reform, therefore, must include an equitable provider payment system in which hospitals and doctors have common financial and other incentives to provide the appropriate level of effective care. This will result in 1) the provision of quality, appropriate care in the most cost-effective setting, 2) elimination of unnecessary care, and 3) reduce the substantial variability in the use of diagnostic and treatment resources to produce the desired outcome.

A system which provides access for all, including the one-third of L.A. County currently uninsured, will go a long way to addressing the waste resulting from the uninsured delaying treatment until the last possible moment and not seeking low-cost early intervention. But we must also aggressively pursue solutions to drug addiction, violent crime, AIDS, homelessness, rampant weapons-related injuries, child abuse, alcoholism, smoking and widespread poor lifestyle habits.

What will not fix the problem are Draconian, arbitrary and unrealistic price controls. Last year in six Southern California counties, 57% of the hospitals operated in the red, and many of those were located in inner-city and rural areas where access is already problematic.

THOMAS M. PRISELAC

Chairman of the Board

Hospital Council of Southern California