Wilkes-barre

Agnes Walsh 
Jan. 11, 1994 
Agnes G. Walsh, 91, Of Wilkes-barre, Died Tuesday In The Heritage House, 
Wilkes-barre, Where She Resided.

Friday, January 14, 1994 &nbsp;&nbsp;&nbsp;&nbsp;Page: 





Limits on health care choices are inevitable &nbsp;&nbsp;&nbsp; 
 Here are three predictions1. Local newspapers, including this one, will
generate dozens of stories about the Wyoming Valley's health care system over
the next few months. The quotes, counter-quotes and letters-to-the-editor will
fly. &nbsp;&nbsp;&nbsp; 2. The coverage will center on the reduced number of choices that patients
and doctors are being given these days. &nbsp;&nbsp;&nbsp; 
 3. None of it will make much difference. Choices will keep being limited
almost without regard to what the media (or the public) does. &nbsp;&nbsp;&nbsp; 
 In other words, the whirlwind of medical competition has touched down in
the Wyoming Valley, and we've got about as much chance of taming it as we
would an honest-to-goodness tornado. &nbsp;&nbsp;&nbsp; 
 Too harsh an assessment? Frankly, we hope so. We'd love it if all insured
patients could choose their doctors, all doctors were welcome at every
hospital and all services were covered by every health plan. &nbsp;&nbsp;&nbsp; 
 We'd love it -- but we don't expect it, not now and not in the future.
Here's why. &nbsp;&nbsp;&nbsp; 
 It's too expensive. &nbsp;&nbsp;&nbsp; 
 That level of care costs too much. &nbsp;&nbsp;&nbsp; 
 After all, that's why America unleashed competition in health care in the
first place. The old way, which roughly resembled the ideal described above,
simply got too pricey. &nbsp;&nbsp;&nbsp; 
 Back in the 1960's and 1970's, health maintenance organizations were
virtually unknown. Nearly all insured patients (including people on Medicare,
the federal government's health plan for the elderly and disabled) belonged to
"fee for service" plans, which paid doctors and hospitals for whatever got
prescribed. &nbsp;&nbsp;&nbsp; 
 But predictably, the perverse incentives in such a system spun its costs
out of control. Doctors not only had no incentive to economize care; they were
encouraged to maximize it. Why worry about costs when the government or an
insurer will pay for everything you do? &nbsp;&nbsp;&nbsp; 
 Ethics are easy in such an environment. Of course all patients should have
the "right" to choose their doctor -- as long as someone else pays the bill.
But as soon as patients themselves have to pay, or companies and hospitals
feel the pinch of patients' costly choices, that "right" turns out to be a
very expensive luxury. &nbsp;&nbsp;&nbsp; 
 (Remember, all veterans used to have the "right" to a free college
education. But so many of them exercised it that Uncle Sam eventually watered
down the World War II-era G.I. Bill, and today's vets don't get anywhere near
the same subsidy.) &nbsp;&nbsp;&nbsp; 
 In health care, the Reagan administration injected competition into
Medicare in the early 1980s. Where the government used to pay for every test
and treatment, suddenly it paid only a set amount for every disease. That
forced hospitals to keep their costs down. &nbsp;&nbsp;&nbsp; 
 And the race to adjust to the new marketplace was on. &nbsp;&nbsp;&nbsp; 
 That race has upturned health care across much of the country. In many
places, exactly the same scenarios that now face our Valley have played
themselves out. Hospitals have merged, hospitals have closed, doctors have
been dropped from insurance lists, patients have been told they have to change
physicians. &nbsp;&nbsp;&nbsp; 
 We here in Northeastern Pennsylvania are simply catching up. And we'll
learn, as others have, that this force of competition -- call it "win or die"
-- is too big for us to control. &nbsp;&nbsp;&nbsp; 
 Oh, sure, we might affect the changes on the margins. Public pressure could
force a health plan to accept some doctors that it had dropped. A charity
drive could keep a struggling clinic open that might otherwise close. &nbsp;&nbsp;&nbsp; 
 But the trends are here to stay. Competition will give us great quality at
reasonable cost. It also, however, will show us that free choice in health
care is phenomenally expensive; and unless we're willing to pay that extra
bill , we can expect our choices to dwindle.

Limits On Health Care Choices Are Inevitable Here Are Three Predictions.