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Local Corporations Tried to Control Health Care Costs Before, and They Failed

By Ben L. Kaufman · March 1st, 2010 · On Second Thought

General Electirc boss Jeffrey Immelt wants major businesses to create a regional cooperative to deal with major shortcomings — limited access, rising costs — of our health system. I quote The Enquirer:

“Immelt outlined a possible plan that could include combined insurance coverage shared among area companies. The plan would include a wellness treatment and education campaign and a regional health care information exchange between hospitals, doctors and insurance companies. Finally there would be an effort to apply business practices to local hospitals to help improve efficiency and lower costs.”

He told the Cincinnati USA Regional Chamber's CEO Roundtable, "What we need to do is take the five biggest (diseases) in this city and we ought to converge all of our benefit plans to have the same standard of care. And we need to buy together ... we ought to converge plans to provide the greatest coverage that we can."

Something similar was tried in 1992. Facing threats to their fees, unhappy physicians used scare tactics to predict a health care crisis as specialists left for more lucrative cities. Resistance continues, The Enquirer noted, but there was more to failure.

So I asked an active observer of that earlier corporate project what happened. It was better and worse than The Enquirer told us:

“The big four employers (P&G, Kroger, GE Aviation and Cincinnati Bell) basically sought to control costs by demanding that hospitals demonstrate cost effectiveness — not necessarily just low bids but a real emphasis on quality — and then throw their money and employees to the top performers. The hospitals all freaked out and immediately started forming groups to shave down duplicated business costs such as billing, HR, etc. Thus were born the Health Alliance and TriHealth and a revamped version of the Mercy hospital group. It also ushered in the heyday of ChoiceCare and HMOs, which did go to war against high specialist fees with limited temporary success.

“That was the ‘easy’ part, and indeed many millions were saved. Hospital costs in Cincinnati did slow down a lot. Of course we now see how well the Health Alliance worked out.

“And that traces back to the hard part: consolidating actual medical services. The specialists literally at the individual doctor level could not or would not get behind the 'centers of excellence' idea. The idea was if the city had three cancer hospitals and needed only two or only one then the employers would help the nonprofit hospitals work out which center should be the one. But that process meant that some very accomplished doctors would lose their programs or would have to become junior partners to some other doctor.

“Way too many egos in the field to pull this off even though logically it makes sense. The folks at UHospital and Christ Hospital never could agree on these kinds of consolidations. Ultimately it killed their ‘marriage.’ We are living through the divorce right now.

“So I see an attempt to repeat history here with the new GE proposal. Unless doctors get on board — and they won't — the idea cannot fly.

“Meanwhile, doctor claims about an exodus of specialists were mostly overblown. Managed care did attack specialty fees. Some doctors did choose to retire early to get out of the hassles, and many bemoaned the future of medicine.

“But as managed care spread nationwide, doctors learned they had nowhere to run. Overall the supply of doctors has not changed in the past 15 years in any alarming ways. There are shortages in rural areas and in mental health, but there always have been shortages in those areas. We don’t have a shortage of overpriced cardiologists or orthopedic surgeons or cancer docs.

“The nation probably could still benefit from some cost control pressure on specialists. But that's not likely to happen unless the economy keeps on tanking and people just flat out cannot pay. Otherwise, if we can pay we will.”


Curmudgeon Notes

• Reporters covering Christ Hospital’s campaign to certify restaurant dishes as "heart healthy" (low fat, low calorie, low salt, etc.) should ask about Wendy’s in the hospital lobby. It serves staff and visitors and is a rare eating spot for residents of Mount Auburn.

• Read the Feb. 24 post on petebronson.com about the failed Empowerment Zone program. He credits The Enquirer’s Jane Prendergast for her reporting but goes beyond the implications in Jane’s story: Public funds mishandled in black neighborhoods by blacks rarely are subject to the kind of scrutiny that public spending requires. This inattention robs the poor and is classic Cincinnati racism, as in, “What do you expect of those people? It’s money for them to steal.” Bronson excoriates The Enquirer — for which he was a columnist and editorial page editor — for its cowardice, suggesting fear of being accused of racism often restrains any sense of duty as a public watch dog.

The Empowerment Zone is not the first fiasco of its kind involving years of willful ignorance and timidity.

• Bill Sloat is writing thebellwetherdaily.blogspot.com again. That’s good news for anyone who cares about public affairs. One of his openers is a federal sex discrimination suit by two fired faculty members against Xavier University. The women contend they were forced out because they complained about pay disparities; XU says they couldn't get along with colleagues. Other media missed or ignored the litigation. Based on testimony in a UC faculty sex discrimination trial that I covered, even Cintas won’t be able to handle the volume of dirty laundry if the XU case goes to trial.

• Ben Fischer’s analysis of minority hiring for Cincinnati school construction is good Enquirer explanatory journalism in the midst of unhelpful name-calling and defensiveness at school board meetings. Barry Horstman’s lancing a barely hidden boil in the top ranks of the Cincinnati police department is a hoot in the same Sunday Enquirer. There’s a he-and-she, a he-doesn’t-like-me, suggestions of sexism and racism, and Chief Thomas Streicher trying to keep the kids in line.

• Channel XIX broadcast a stunningly dumb story: A 12-year-old with a Tech-9 pistol held two Cincinnati police officers and a third person at gunpoint. Most of the story involved the juvenile detention center in Mount Auburn where the kid apparently was taken. Nothing from police. Nothing from the third person under the gun. No suggestion how cops arrested the kid without being shot. And then the seriously weird tagline, to the effect that no weapon was found at the scene. Let’s see: The kid has a cheap, nasty 9mm semi-automatic weapon popular with drug boys, three adults at gunpoint, an arrest and no weapon is found? At least tell us how they knew it was a Tech-9 that they couldn’t find?

The New York Times won a Pulitzer for telling us how cable and networks hid the conflicts of interest involving talking heads posing as military “analysts.” The Nation takes it further, looking at other TV “analysts” who had rich ties to the industries about which they speak. In short, and especially on finance programs, we get shills rather than disinterested analysis. Broadcasters deliberately hide these connections from listeners/viewers.

The Nation also reports on worker-owned co-ops springing up in Cleveland. Local foundations help assure startups have resources to succeed. If The Enquirer can send a reporter and photographer to Haiti with local relief teams — which I applaud — maybe Cleveland is a worthwhile destination. It sounds as if Cleveland is in the mental empowerment zone.

• London dailies ran seemingly unrelated stories about young tarts, rich and/or powerful protectors/clients and at least one boyfriend whose violent behavior required police intervention. The stories appeared daily next to each other on Page 1. It was a signal to readers that more was to come, but Britain’s fierce libel laws meant it was too early to print what we reporters knew. Eventually the stories merged: The underlying society/security scandal erupted, the government almost fell and someone made a movie.

Jump to 2008. The New York Times runs a curious story on John McCain’s relationship to an attractive, younger blonde lobbyist. The Times put a lot of effort into its probe but generated little more than titillation and updated versions of “Where’s the beef?”

One of the hardest things is to walk away from an investigative effort that doesn’t pan out. The urge to publish what you know can be overwhelming, even when the original suspicion is unproven.

I’ve been there. I’d spent weeks with a Pulitzer-winning Gannett News Service reporter looking for proof that Chicago’s Cardinal Cody abused archdiocesan finances on a grand scale. Rumors were rife. Roman intrigue was Byzantine. Coincidental evidence was everywhere. I was involved because Cincinnati Archbishop Joseph Bernardin was tipped to be Cody’s replacement (and maybe the first “American pope.”)

Going into the project, we agreed to publish only if we could show Cody committed a felony. Cody could be high-handed, but that was old news. We didn’t find a misdemeanor. Even Cody haters couldn’t provide a “smoking gun.” We’d drilled a dry hole. We didn’t write a word. It wasn’t easy to walk away.

I was lucky to have a solid local editor at The Enquirer, former investigate reporter Jim Delaney, who assured me he’d drilled dry holes. You recheck your notes, your sources and your approach, and if there still is nothing there you move on.

In the past month, New York politics and journalism have been roiled by rumors of a Times story to bring down unpopular Gov. David Patterson a la Elliot Spitzer. Patterson even called a news conference to demand the Times come clean. The Times ignored him. Within days, we got the Page 1 story about his driver, aide and confidant who has a criminal record and, the paper suggests, problems with women. It was even less substantial than the McCain fiasco. There was no beef there.

Now we know why they ran the first story. A second story suggests that top state officials protected that aide from a domestic violence accusation, even to interfering with a court witness. Patterson refused to resign but said he won't run in the coming election.

• Meanwhile, The Times briefly delayed its scoop on the arrest of a senior Taliban commander. The White House — contacted for comment — asked the paper to hold the story so that Americans might gain vital information while other Taliban leaders were unaware of their loss.

Times Editor Bill Keller told the public radio/online show The TakeAway, “I don't have spies in the National Security Agency, so knowing whether publishing a story would actually put national security at risk is a harder thing for me to figure out ... but we do our best, and we take these requests quite seriously.”

He continued in part, “Folks at the White House said ... we need to talk to you about this, and several of the people from our Washington bureau went over to the White House and sat down with people from the National Security Council and the press office and they said that they were pretty sure that Mullah Baladar’s colleagues in the Taliban were not yet aware that he was in custody. I don’t know the details of it, but they thought it had been a clean snatch and they were afraid once the word got out, other Taliban officials would go deeper underground or take measures to cover their tracks, so they asked us to hold off for a while.

"This one was not, honestly, a very hard call. Obviously we were eager to break the story, it represented a lot of resourceful reporting ... but there was no obvious public interest reason to rush the story into print and ... we didn’t want to compromise what sounded like a possible intelligence coup. ... Yesterday our stringers in Pakistan and Afghanistan started calling our bureaus there and saying, 'We’re hearing reports that Mullah Baladar is in Pakistani custody,' we took that to the White House and they said, 'Yeah we understand it’s not holdable anymore.' ”

• Too many local and national news media killed the best line in Down Syndrome actress Andrea Fay Friedman’s rebuke to angry Sarah Palin: “My mother did not carry me around under her arm like a loaf of French bread the way former Governor Palin carries her son Trig around looking for sympathy and votes.” Trig has Down Syndrome. Friedman is the voice of Ellen, the Down Syndrome cartoon character on the TV show Family Guy.

Palin was provoked by Ellen’s line, "I am the daughter of the former governor of Alaska." Friedman said the line was meant to be funny and sarcastic. “In my family we think laughing is good. My parents raised me to have a sense of humor and to live a normal life.” Palin reacted on Fox, saying Family Guy “really isn’t funny. ... This world is full of cruel, cold-hearted people who would do such a thing.”

Palin’s daughter Bristol added on Facebook that if “the writers of a particularly pathetic cartoon show thought they were being clever in mocking my brother and my family,” they failed. “All they proved is that they’re heartless jerks.”

• Families adopting dark-skinned Haitian children have fair skins, and the stories — barring the botched Idaho church group mission — are upbeat. How about a story on children of similar ages and color locally who are waiting for adoption while Haitians and their adoptive families are lionized? And, if there still are local bureaucratic barriers to interracial adoption, that would be a story, too.

• Hunter Thompson was famous for his drug-induced political reporting: vivid, closer to truth than many sober Boys on the Bus. I’m from the Reality Is for People Who Can’t Handle Drugs generation, and post-op Percocet proved it in my Feb. 17 column. A reader quickly caught an error — Senators Sherrod and Scott Brown are related — when it is Scott Brown and Obama who reportedly are related. I also mistakenly referred to unlimited corporate contributions to candidates when I meant ads to support a candidate’s campaign. I caught that one before anyone called it to my attention and CityBeat corrected both online, for which I am grateful.


CONTACT BEN L. KAUFMAN: editor@citybeat.com

 
 
 
 

 

 
 
 
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