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Health reform: Many questions, few answers

It seems everyone has an opinion about health care reform -- there are plenty of options on the table, but there isn't a specific plan yet, leading to questions and concerns.

For Paulette Amundson, who oversees the regional clinics for MeritCare, including the clinic in Detroit Lakes, it's even harder to have an opinion on a bill that doesn't exist yet.

"I don't think we have a really clear picture of what they're discussing, of what it would actually mean," she said. "There needs to be lots of research, communication and clarification. I don't think we can say right now that what they have is the way to go."

Still, just about everyone can agree that the status quo needs to change, including St. Mary's Innovis Health Center's CEO Tom Thompson.

"Our national cost expenditures are unsustainable," he said.

And what makes the issue so complex is that there are so many stakeholders, he said.

"There's you and me, there's large public groups like the AARP, there's the pharmaceutical industry, the insurance industry, there's just a tremendous number of folks that have a lot to lose," he explained.

Still, Thompson said he believes that any new health care bill should provide basic, primary healthcare for everyone, rather than people without insurance resorting to visiting emergency rooms.

"Everyone should have a relationship with a primary care physician," he said. "An emergency room is not that, it's episodic care, and it's very expensive."

A "public option" has repeatedly been talked about in the debates, and for Amundson, that's a good thing since she said she isn't sure whether a "public option" is the answer.

"That's really difficult to answer because you want everyone to have some kind of coverage, so that would lend itself to looking at (a public option)," she said, "but on the other hand, those that have been in a public health care, like Canada, many of providers have moved to the States to move away from that, so I don't know a public option is the way to go. I think it needs a lot more study."

Thompson, and St. Mary's parent organization Essentia Health, is concerned that a "public option" would be along the same repayment scheme as Medicare, according to a letter from Essentia Health executives to congress people from Minnesota, North Dakota and Wisconsin.

The letter stated that the three states have one of the more cost-efficient systems in the country, but are also on the low end of receiving Medicare reimbursement.

"The issue for us is that if you have a public option, if the government is going to base a public option on the existing payment system, where we're already losing money, that's completely unsustainable," Thompson said. "We won't be here. No one will be here."

Thompson said St. Mary's Innovis Health is in a "particularly difficult position" under the current Medicare payment structure.

"(It's a) 'tweener' hospital -- too 'big' to gain preferential treatment under the Medicare program like other neighboring rural hospitals (e.g. Park Rapids), and too 'small' to reasonably host services found in larger, more urban centers (e.g. Fargo)," he wrote in an e-mail.

St. Mary's loses more than $3 million every year serving Medicare patients, Thompson wrote, and an additional $1 million serving Medicaid patients, a figure projected to grow since Gov. Tim Pawlenty has eliminated the General Assistance Medical Care program, effective March 2010.

Amundson said decreasing the overall costs of medical care is the key to reform, "but I'm not sure that they've found the exact way to do that yet."

One way she said MeritCare has become more efficient is to convert patient records to an electronic server, an investment estimated at more than $100 million over the last 12 years.

And although he said there should be primary care for everyone, Thompson said he doubts the "public option" will happen.

"I highly doubt that a large scale public approach is going to prevail," he said. "I think there's such a huge insurance lobby that that won't happen."

No matter what, both Amundson and Thompson said health care reform is something that Congress needs to research long and hard, and do right the first time.

"My personal observation is that for many years, there's been a lot of talk and little action on health care reform, and all of a sudden a huge amount of energy is being put into it, with a seemingly artificial timetable," Thompson said. "We need to do this right, and personally, I believe that we do need to talk about fundamental change to the health care system and not this continual nibbling around the edge. It has to be very comprehensive and well studied, and it can't be a completely partisan approach."