Beebe chief: Health-care industry is sick
By Bruce Pringle
Delaware Coast Press Reporter
Like a doctor warning a patient to change his lifestyle today to avoid pain and suffering in years to come, the president of Beebe Medical Center says the nation’s health-care industry should act now to ensure it will be strong in future decades.
Jeffrey Fried, Beebe’s top executive since 1995, admits he doesn’t have easy solutions to existing problems caused by steadily rising health-care prices — or to challenges posed by an increasingly elderly population. But he does offer one prescription: a serious search for an alternative to a health-care system that, he says, cannot survive as it is.
“I don’t know all the answers, and I don’t know what the eventual solution is,” Fried said in a recent interview at his office on Beebe’s campus in Lewes. “But what I feel most strongly about is, the current system simply is not sustainable. So we ought to be looking at all the different possibilities and all the options right now.”
Current conditions — from millions of workers without health insurance to millions who have insurance that fails to provide comprehensive preventive medicine — may seem severe, but Fried said worse could be on the way as the number of retirement-age Americans rises. He noted federal statistics showing that in the year 2000 there were 3.9 tax-paying workers for every person on Medicare, but in the year 2030 the ratio will be just 2.4-to-1 — nearly 40 percent lower.
Already, he said, the federal government fails to fully reimburse any Delaware hospital for its Medicare expenses. Other patients’ payments make up the difference, a situation that could be exacerbated unless the health-care system is overhauled.
“So you’ve got an aging population, and we know an aging population uses more health-care services than younger people. And you’re going to have fewer people working to provide those services,” Fried said. “To me, that’s a train wreck waiting to happen.”
But little, he said, is being done to head off the collision. “The thing that frustrates me is that these statistics aren’t somebody’s private information,” he said. “They’re available to anybody. I don’t understand why people don’t see what’s looming on the horizon.”
Government’s role
He calls for government to lead the way. But one prominent government attempt at such leadership, during Bill Clinton’s first term as president, failed to spark dramatic change.
“You’ve got all kinds of people (in health care) who want to make the system better for (themselves), and nobody wants to give up anything,” Fried said. “Hillary Clinton tried to put everybody around the table. The problem is, everybody comes to the table trying to make the system better for themselves.”
But another effort should be made, he said, because the free-enterprise system isn’t geared to meeting the challenge on its own.
“I used to believe that the competitive model that works for the rest of the world would work for health care. The more time I spent in health care, the more I realized it doesn’t work,” said Fried, who was an executive at Lancaster (Pa.) General Hospital for 12 years before moving to Beebe. “The reason it doesn’t work is that, first of all, you don’t have a level playing field.
“You have hospitals providing all the services needed in a community, regardless of (patients’) ability to pay,” he said. But there also are “niche players who go after certain kinds of patients with certain kinds of services and aren’t really interested in serving the uninsured and the underinsured. You’ll see imaging centers going up, you’ll see surgery centers going up and you’ll see endoscopy centers going up. But these facilities aren’t interested in taking care of the uninsured.
“And pharmaceutical companies are developing new medications all the time. Medical-equipment companies are developing new technologies. But nobody’s really interested in providing services for people who can’t pay for them.”
Meanwhile, he said, insurance companies continually strive to enhance their profits by paying health providers less for services received by those who do have coverage. And that coverage isn’t always comprehensive; not everyone who is covered is assured of undergoing medical testing that would save money in the long run.
“So much of our system — I’m not saying it’s bad — is driven by the stock market, the capital markets and what’s happening on Wall Street and similar places around the world,” Fried said. “The market goes up and down based upon quarterly performance reports. The problem is, preventive medicine isn’t based on quarterly reports. You’ve got to make some investment over time to really see any benefit.”
Covering everyone
While the American Medical Association and many other forces within the health-care industry insist radical change isn’t necessary, Fried is among those calling for serious consideration of instituting the “single-payer universal” system common to many other industrialized nations.
Under single-payer, a government-run organization would collect all health-care fees and pay all medical bills. Advocates such as Physicians for a National Health Care Program say that replacing today’s complex billing system would save money that could be used to provide care for those who currently don’t get it. Under single-payer, all Americans would be covered and current health services would continue. Private insurance no longer would be necessary.
Some opponents of single-payer say the government would spend too much. Others predict the opposite, saying government wouldn’t spend enough to ensure patients received all the care they needed.
“I’m not sure single-payer is the right answer,” Fried said. “Maybe we’ll come up with a solution nobody has thought of. One of the great things about this system is that the entrepreneurial spirit has always allowed us to come up with new discoveries and look at things differently. Just to say ‘This won’t work’ or ‘That won’t work’ is not acceptable to me.
“My position more than anything else is, the current system doesn’t work. It isn’t going to last forever, so we’ve got to start thinking about something else. And the longer we wait to think about something else, the less time we have to do something before it becomes a crisis. It seems to me people would do best to deal with these problems now rather than waiting 10-20 years down the road.”
E-mail Bruce Pringle at bpringle@smgpo.gannett.com.
Originally published Wednesday, June 9, 2004