As a member, I had carefully selected my family's primary care doctor from those allowed on the IHC list. Without telling me, my doctor was "deselected" and my family was unilaterally moved to a different primary care doctor.
When I mistakenly went to my "own" doctor, IHC denied payment. On another occasion, my 4-year-old had a facial infection. I took her to Primary Children's Hospital for urgent care. As it turned out, she had a tooth abscess. Again the bill was denied because I should have taken her to a dentist. Patients and physicians all over Utah are tiring of these heavy-handed practices by IHC.
But IHC leadership perceives that they must be aggressive, or they will not remain in business. For-profit health institutions have only one fiduciary duty: to make as much money as possible for the investors. These institutions are now commonly pushing the envelope of acceptable accounting and billing practice in order to improve the investor's bottom line.
HCA, the world's largest for-profit hospital chain and IHC's major competitor in Utah, agreed to pay more than $1.5 billion on federal fraud charges and still posted 50 percent gains in profit. With its deep pockets and aggressive style, HCA threatens IHC's existence. To stay afloat, IHC has developed the tactics that are distressing their patients.
But punishing IHC will not improve the plight of Utah's patients and physicians. Taking money from IHC and giving it to the education system, as had been proposed, would worsen the situation.
We need discussion of our sick health-care system beyond the misdeeds of the health-care insurance companies. We must discuss what market forces will do to us when we are ill and unable to pay. Market forces can only work in our favor if four prerequisites are true: 1) anyone can sell 2) buyers know enough to buy 3) people who buy or sell poorly are allowed to fail and 4) buying and selling affect only the buyer and seller.
None of these prerequisites is true of health care.
Health professionals and institutions, the sellers of health services, are highly regulated and have an ethical responsibility to place the needs of the patient before their own interests. Patients, the buyers of health care, usually know little about what health care they need, how to judge its quality, or even what the diagnosis is.
Patients who fail to take care of their health are treated nonetheless. Hospitals and physicians serve everyone. Finally, if your neighbor with tuberculosis doesn't get treatment, you are affected, too. In short, the demand for health care is determined by the incidence of disease as well as the diagnostic and therapeutic expertise of the medical profession, not by price. Business as usual in the health sector has brought us to the crisis that we are in today.
The fact that IHC is a successful health-care corporation means that they are particularly good at exploiting the market mirage that is American medicine. Understandably, patients and physicians are tiring of IHC dominance in Utah, creating the legislative backlash. But singling out IHC for punishment ignores the underlying causes for our health-care problems. IHC did not become "monopolistic" because it violated the rules of a free market. Rather, the emergence of the IHC "monopoly" is itself ample testimony to the real status of health care: Health care is not a commodity, it is a public good, universally needed to succeed in modern life just like good roads, education, police and fire protection and the information superhighway.
The Utah Legislature can best serve the electorate by adopting a set of principles for health-care reform which will guide health policy beyond the mirage of market. I recommend the following six principles:
1) Assure that all Utahns have financing for medically necessary services. The Utah Medical Association, the Utah Public Health Association, the Utah Nurses Association and virtually all health professions agree: When care is needed, financing should be provided.
2) Assure that all Utahns are unrestricted in choosing their health care provider. The physicians spearheading the legislative momentum for patient choice reform are correct: Quality health care is primarily founded on the physician-patient relationship.
3) Universal health care financing with unrestricted choice of doctor must not increase per capita health-care costs. We are already paying twice as much per capita as any other nation in the world, which is enough for universal health care financing with unrestricted choice of doctor.
4) Reduce administrative overhead in health care from current levels to below 5 percent of total revenues. According to a study published in 2003, a reduction of overhead for private sector health programs below 5 percent would save as much as $1.6 billion per year in Utah, enough to fund medically necessary care in the state.
5) Reorganize Utah's health financing as a cooperative, owned and operated by the entire Utah community for the benefit of each resident. A non-profit, private trust fund authorized by statute to be the sole payer for health services in Utah should be established; 60 percent of current health funding is tax money anyway and should be administered for the benefit of all in the community.
6) Health-care delivery should remain in the private sector. Doctors need the freedom to choose their type and place of practice. Hospitals and other institutions are best managed as private, non-profit institutions.
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Dr. Joseph Q. Jarvis is president of the Utah Health Alliance.
