NATIONAL HEALTH CARE REFORM SPARKS WORRY ABOUT HIGH COSTS

The administrator of Southeast Missouri Hospital says he's worried the nation might end up emulating Canada's health care system.

"I'm just really concerned that when all of this shakes out (on health care reform), that whatever we have in this country is going to very closely come to the Canadian system," said Jim Wente, administrator of the Cape Girardeau hospital.

"The concern I have about that is, I don't believe the constituency in our country really understands that they are still going to pay for that," said Wente.

Funding of such a universal health care system would come from higher payroll taxes, he pointed out. "There's going to be less money in those paychecks because to finance the health care for this country under a system that is patterned after the Canadian universal system of health care is going to cost a lot of money."

Ultimately, that could lead to "yet another reform that is going to try and bring back free choice, less costly services" in health care, he said.

"It may take 20 years for the whole cycle to happen," said Wente, "but I think if we really do move toward universal health care that there's going to be a greater access problem; I think there's going to be younger people who are going to be less likely to go into medicine because they'll earn better livings in other professions, and it's going to be very, very costly."

John Fidler, president of St. Francis Medical Center in Cape Girardeau, agrees that cost is a concern in all the talk of national health care reform.

As a hospital administrator, he said he follows the national health care debate "because with one stupid change in the health care law, you can rewrite health care at the local level."

Fidler said any national legislation to reform the health care system will have to deal with a number of issues.

"Number one, you have strong union support. We've had rich benefit packages. Six of 10 strike-related issues are for retention of health care benefits," said Fidler.

"So I think there's a pretty good probability that whatever package they put out, it has to be liberal enough to support that," he said.

In addition, some proposed benefits are currently not provided under Medicare.

"What about catastrophic insurance? We all know what happened with that awhile ago," said Fidler. "It quickly got passed and then when the elderly realized they'd be paying for a portion of it, it quickly got repealed."

Fidler said that with any national health care system, there is a concern about the added cost to businesses.

"So I think there has to be some kind of pooling of risk, a phasing in of those things," he said.

It's estimated there are now 37 million Americans who don't have health coverage of any kind.

"You obviously can't take 37 million people, some people would say 20 percent of the population, provide them health care access and not have an increase in cost unless you found a lot better way of providing health care," said Fidler.

"I think what we anticipate," he added, "is that there will be a pluralistic system and there will be another payer source for people who currently don't have ready access to either a Medicaid program or some other form of health insurance."

Wente said the federal government's current health care reimbursement programs have contributed to the cost problem.

He said that changes in the Medicare reimbursement system, which were implemented in the 1980s, have hurt hospitals financially.

In 1984, Southeast Hospital's Medicare reimbursement slightly exceeded cost. "We had 3,156 Medicare patients and we made $7.32 on each one of them on average," said Wente.

In 1992, however, the treatment of Medicare patients proved to be a losing proposition. "In 1992, we lost 22.4 percent on Medicare. In other words, for every dollar we spent in caring for the Medicare patient, we got 77.5 cents back," said Wente. "We lost on every Medicare patient and there were 3,042 of them in '92. We lost $1,766.88 (per patient) on average."

Last year, the hospital incurred a total cost of $23.95 million in caring for Medicare patients. Medicare reimbursed the hospital for $18.58 million of that cost, leaving Southeast with a $5.37 million loss.

In the 1992 fiscal year that ended June 30 of last year, St. Francis lost $5.67 million on treatment of 3,829 Medicare patients. The hospital had total reimbursements of $19.44 million compared to costs of more than $25 million.

Wente said one way to look at it is that the two hospitals combined made "a social contribution of over $10 million last year to provide care."