Employers, Care Providers Join Forces to Fight Insurers

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Los Angeles Business Journal

Realizing there is strength in numbers, the Foundation for Taxpayer and Consumer Rights is attempting to build a coalition of medical professionals and business leaders to wrest a bigger piece of the health care pie away from the giant health maintenance organizations.

Jamie Court, executive director of the Santa Monica-based foundation, said the group has joined forces with the California Medical Association and the California Nurses Association. Currently lacking a detailed agenda, the group wants to address the rising costs of health care and to examine ways to provide care for the nearly 8 million California residents who are uninsured.

“The only way to achieve a more reasonable system is to gather people who have a stake in this,” Court said. “That means bringing people from seemingly divergent groups who have fought more than they’ve agreed, like doctors and nurses, together in everybody’s self-interest. The important thing is to get people on the same page, working on a solution.”

People who won’t be involved are those representing HMOs.

“HMOs are not invited,” Court said. “They’re the ones causing the problems. They’re the ones gouging prices and spending big bucks on themselves at other people’s expense.”

To help draw the attention of business interests, primarily small businesses, longtime Washington operative Joel Marks has been hired to orchestrate the effort. Marks is the founder and former director of the American Small Business Alliance.

“A lot of small businesses can’t afford to provide health coverage,” Marks said. “They’ve been priced out of the market. Many of the uninsured work for small businesses. The uninsured come mainly from the working poor who make too much money to apply for Medicaid.”

ER overload

Steve Thompson, vice president of government affairs for the California Medical Association, pointed out that emergency rooms often become the primary care facilities for the uninsured because ERs by law are not allowed to turn away patients. This, Thompson said, has resulted in the closure of dozens of hospital emergency rooms in the past 10 years.

“Some hospitals just can’t handle the financial burden of keeping their emergency rooms open,” Thompson said from his Sacramento office. “State funds don’t offset all of the people not paying health costs.

“Unless we address the issue of millions of people being uninsured — and address it fast – the situation will continue to worsen,” Thompson said. “Physicians and hospitals are going bankrupt, while HMOs are making record profits.”

According to Thompson, about 85 percent of the California health care market is controlled by HMOs.

Sara Nichols, legislative advocate for the Sacramento-based California Nurses Association, said that providing universal health care is her organization’s goal.

“Nurses and doctors don’t always see eye-to-eye politically or on the job, but in this case, nurses and doctors are united for universal health care because it’s the only way to wrestle control away from the for-profit corporations that currently dominate health care,” Nichols said.

Nichols is a strong proponent of a broad government-supported Medicare-type system so that all people would be covered.

Grants sought

To get the message out about the effort to unite health providers, Court is seeking $ 100,000 in grant money from private foundations to set up a series of town hall meetings in six California metropolitan areas: Los Angeles, Orange County, San Diego, San Francisco, Sacramento and Fresno.

“We’re expecting big turnouts,” said Court, author of the book, “Making a Killing: HMOs and the Threat to Your Health.” “We’re putting together a well-paid, well-educated, articulate force banding together in a form of revolution.”

Bobby Pena, spokesman for the California Association of Health Plans, said he and his group agree with the need to address the problem of the uninsured.

“They’re right about more than 7 million people in California and 44 million people in the U.S. not having health care, and it’s embarrassing,” Pena said. “I agree with that.”

What Pena doesn’t agree with is the attack mentality of Court and his colleagues against HMOs.

“It’s unfortunate this group is pulling people together to bash managed care,” Pena said. “If HMOs didn’t exist, a lot more people would be uninsured than there are now.

“HMOs are caught between a rock and a hard place,” said Pena, who cited a typical HMO’s yearly profit margin at “about 2 percent” after expenses. “Lower costs are demanded on one side (by businesses and patients) and more money is demanded on the other side (by doctors and nurses). If my industry has been too slowmoving in some things…it’s the conflict of trying to keep costs down that makes HMOs cautious.”

Could universal health care be achieved through HMOs?

“I would say yes,” Penn said, “but I doubt that the government would want to pay the cost of that.”

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