The moral of the UMC story is that we must develop new approaches to health care that merge government and private enterprise with individual responsibility.It is no surprise that the recently announced budget cuts at UMC have made front page news. Concerns have been expressed by multiple stakeholder groups that this crisis is but one step toward a complete meltdown of UMC and the irrevocable negative impact on our quality of life.
Taken individually, the job eliminations, reductions and relocations of physician training programs and fear of reduced access to care are each newsworthy. Taken together, it presents a tsunami-like catastrophe as the first waves of the state’s budget crisis hit our local health care shoreline.
Crisis it is, but surprise it is not.
Pundits point to everything, including Hurricane Katrina, the state constitutional flaws in budget matters, allocation of UMC’s revenue to other Charity System priorities and the Accountable Care Act, as drivers of the UMC program cuts. No doubt that all have contributed to the timing of the announcement, but none stands alone as the primary cause of UMC’s difficulties.
In my view the culprit is the collective failure of all the key stakeholders in this arena — the federal government, state leadership, private enterprise, LSU, hospital and physician groups, consumers of health care (i.e. you and me) — to work together to change our focus from treating sickness to promoting health. For generations we have taken the “more” approach: more money, more facilities, more services, more medication, more and more. It has been a classic case of treating the symptoms but not seeking the cure.
The uniqueness of this moment is there is no longer any revenue cavalry coming to the rescue. The federal government is both broke and in interminable political gridlock. The U.S. spending on health care is already 18 percent of our gross domestic product, which far exceeds any country in the world. As Thomas Friedman so eloquently expressed, “the world is flat” — meaning in a truly global economy this 18 percent cost of health care becomes a hidden tax on every good or service that Americans produce. As America becomes less pricing competitive in the global marketplace, any attempt to fund our historic spending on health care will add to our spiraling government deficits, shrink economic growth and thus compound our health care budget crisis. It is a vicious cycle that must be stopped.
In many ways the UMC crisis is but one ripple in an interconnected global wave of change that we hoped would never hit us. I have a colleague who is fond of saying that hope is not a strategy. He’s correct, and the moral of the UMC story is that we must develop new approaches to health care that integrate across government, private enterprise and individual responsibility. Winston Churchill said it best: “You can always count on Americans to do the right thing — after they have tried everything else.”
In the case of UMC, the right thing embraces two critical imperatives: sustain and enhance the physician residency and fellowship training programs, and ensure there is adequate access to the best health care solutions for our most vulnerable populations.
As physician shortages worsen around the nation, states are working vigorously on retention rates that coincide with residency programs. More than 50 percent of physicians establish private practice in communities near where they train. A failure to keep these spots will, within a few years, diminish our access to care, hurt our local economy and adversely affect the magnetic appeal that has caused Acadiana to grow.
Our health care system must evolve to public-private partnerships between the state, LSU and our local hospitals and physician groups to move residency and fellowship training to regional facilities and other key hospitals in our eight parish area. Dr. Larry Hollier, chancellor of the LSU Health Sciences Center, is in an ideal position to craft a plan of cooperation, not competition, between entities. We no longer need to tie physician training and access for the underserved to one location. Physician residents can shadow hospitalists, train in school-based clinics or medical home programs all over the region. Effective use of the private sector can reduce the state’s infrastructure costs dramatically in the years ahead. Modeled on the Cooperative Endeavor Agreement between Our Lady of the Lake and Earl K. Long in Baton Rouge, there are similar opportunities to integrate the UMC mission within the non-state hospitals of Acadiana.
Our government and private providers can’t do it alone, which is why we all must realize that the value of the health care dollar rests with the individual.
The greatest expense in health care spending is the treatment of chronic conditions. Our challenge will be to keep our community healthier by methods of wellness and prevention, not treating episodic care. We can fund school based clinics, medical home models and improve prenatal care programs, but we need the commitment of participation. If we could reach youth early enough to teach healthy habits and reduce obesity or help deliver healthier babies, we can fundamentally change the course of our community’s health condition.
The wisdom of teaching a person to fish as opposed to providing a meal of fish is at the heart of our nation’s health care challenge. It is unrealistic to believe every individual will embrace a healthy lifestyle, yet a focus on wellness and an investment in sustaining healthy lives is the right thing to do.
The good news is there are many solutions to pursue. We may not have all the answers today, but as a community, we can refuse to kick the can down the road. Now is the time to collaborate and deploy new strategies that better utilize our resources and improve care. In the words of Martin Luther King Jr.: “Faith is taking the first step even when you can’t see the whole staircase.”
William F. “Bud” Barrow is president and CEO of Our Lady of Lourdes Regional Medical Center and its entities. Barrow has spent more than 30 years in health care administration in multiple states. He serves on the Regional Policy Board of the American Hospital Association and is a current board member and past president of the Louisiana Hospital Association.