San Diego Union Tribune

The current anthrax scare should send an urgent message to employers that they must now grab the extended hand of the medical community in order to fix a broken public health care system that undeniably affects us all.

Trying to run the health care system on profit motive alone, without regard for preserving medical infrastructure, has left society ill prepared to handle a public health scare or major outbreak.

It has never been more obvious that our society needs greater public oversight over the private health system in order to guarantee that resources go not just to HMOs that cut corners but to preserving facilities, people and programs that save lives. California needs a more rational model for health care in the spirit of the old public utility that once preserved the public’s access to and cost of vital resources, such as railroad travel and electricity, during times of war and peace.

In a society subject to the spread of anthrax or small pox, there can be no distinction between public and private health care. Distinguishing between sick people deserving of health care and those not becomes irrelevant when everyone is at risk. Nor does it seem right to deny health coverage to the families of heroic Americans who perished in the World Trade Center towers, or the bombing survivors who lost their jobs, simply because they cannot

pay.

Society needs a new way of thinking that prevents the demands of the private health care system from diminishing the needs of the public’s health. As a key political stakeholder in determining the shape of the health care system, employers must be at the forefront of change.

Employers hired HMOs to get the cheapest care possible in the private health care system. This resulted in the massive closure of emergency rooms, the dismantling of trauma care facilities, and in closure of hospitals. In the hospitals that remain, chronic understaffing has driven experienced registered nurses out of the profession. Such lost infrastructure is needed precisely during a bombing, anthrax scare or small pox epidemic. In addition, the ability of physicians to provide free care to uninsured patients for the public’s health, which was prevalent before HMO cost-cutting, has been eviscerated by underpayments from private HMOs for
insured patients.

Employers believed that HMO control over medicine would reduce costs. Instead, employers have been bedeviled by the twin vices of double digit premium increases and increasing gripes from employees about obstacles to medical care. Employers concerned about the welfare of their employees face a market that allows them diminishing options for coverage, all gravitating to the lowest common denominator, and ever-increasing costs with no end in sight.

In a deepening recession, businesses have been forced either to shift more or all of the payment burdens to their employees, making their companies less competitive and their employees more vulnerable, or have health care costs eat up their profits. Those businesses that cannot afford coverage will have far more concern for their workers’ health in the post-Sept. 11 world than ever before.

Ill-prepared employers also have been thrown squarely into the anthrax crisis. They have been forced to implement procedures both to prevent public health problems and to respond to them when they emerge. Businesses without the ability to afford health insurance now have added worries about the well-being of their workers and whether worker compensation can effectively
cover any serious, long-term health problems that develop on the job.

The time has come for employers to join physicians, nurses, hospitals and patient advocates in creating a model for health care that does not pit the private health care system against the public health system, but brings them together in a more rational way.

The needs of the nation today demand better public controls over private health care delivery and dollars, both of which have run amok in recent years. Such public oversight over private health care could better direct resources to those in need, be they uninsured, underinsured or innocent victims of a terrorist attack. The irony is that such genuine public management of care and cost would save money. Preventing illness is the most cost effective way to treat it, and today’s mismanaged system has failed
miserably on this account as well.

Our groups have reached out to corporations with an employer survey (www.businesshealthsurvey.org) that seeks businesses’ views on health care. If any good in health care is to come from the rubble of Sept. 11, it will only happen when employers, doctors, nurses, patients and hospitals come together to make it happen.

Court is executive director of The Foundation for Taxpayer and Consumer Rights. McVay is president of the California Nurses Association. Thompson is vice president of the California Medical Association.

—