Published: August 19, 2008 11:34 am      

COVER STORY: Healing Niagara's health care crisis

The average citizen doesn’t need a medical degree to know the nation’s health care system is fat, sluggish and battling a host of challenges that threaten not only its life but everyone else’s.

Some who have health insurance watch helplessly while premiums and co-pays rise at levels never before seen.

Many uninsured workers can only hope they won’t have to face that one family health crisis that can bring them to financial ruin.

Those who understand the complex layers of this nation’s health care seem to agree on one thing. Somebody has to fix this mess, because everyone loses when citizens cannot afford health care. Illness can spread quickly when children don’t get immunized. Economies are weakened by consumers defaulting on the medical bills they incur.

Niagara Falls Memorial Medical Center provided nearly $7 million in uncovered, uncompensated health care last year, a figure that did some damage to an already struggling hospital system, according to one spokesperson. The good news is that the Falls hospital recently engaged in a new state program designed to locate those who don’t have health care and find ways to get them insured.

That is one solution that chips away at the gargantuan health crisis as it confronts the Niagara region. There are many more facets in the health care challenge.

Niagara Living recently interviewed a handful of area health care providers and experts to find out, in simple language, how they would cure health care if they could.

Dr. Edward A. Stehlik

Chairman of Internal Medicine

Kenmore Mercy Hospital

“We’re on the verge of the death of primary care,” he said. “We need to fix it, and we need to fix it now.”

Stehlik said that the way medicine is structured now, young doctors don’t want to go into primary care. Currently, primary care is structured in a way designed by health care maintenance organizations that limits the ability of general care physicians to treat their patients.

Stehlik said the national Internal Medicine Society is working on a new model for patient care which is centered around a “patient-centered medical home.” This would involve a physician-led medical team that would integrate health care services for the patient confronting a complex and confusing health care system.

The cost of health care must also be addressed, he said.

“We really can’t afford health care the way it is right now,” he said.

One key to reducing costs is to reduce the variation in health treatments. In different parts of the country, there are different regimens and standards, and treatments are often much more costly than they need to be, he said. “We need to do a rigorous analysis and try to reduce the waste of money.”

Universal health care is essential to any health care cure, he said.

“We must have health insurance and access to health care for everybody,” he said. “Morally, financially, ethically and practically, we really have to do that and until we do, we’re really not caring for our patients, our country, our citizens, the way we should.”

Judith Maness

CEO, Mount St. Mary’s Hospital, Lewiston

“People have an intrinsic dignity, and when we deny them health care we take away that dignity,” she said.

Decades ago, things were different, Maness said: “It used to be if you didn’t have health insurance, you just paid cash.”

Then the government began to provide health care for the aging and disadvantaged, which raised costs for all. Added to that was an explosion of new drugs and technology, which were expensive but helped people to live longer. Now, as people live longer, more people need and expect coverage, she said.

“We don’t really have a broken health system so much as we have a broken payment system,” she said. “Everybody is trying to figure out what’s the best way to provide the right amount of care for the right prices at the right time.

“Our destination is coverage for all.”

To do that, she said, “You’ve got to involve the physicians, the hospitals, the insurance companies and the policy makers, and whatever plans they come up with have to be financially viable for all concerned.

“First we have to get all the people to agree we have a problem. Then we have to get them to agree to the basic principles of how to fix it. It’s got to take the best minds from each sector.”

Maness recently went to Albany to meet with Rep. Louise Slaughter, D-Fairport, and Sen. Charles Schumer, D-N.Y., asking for several things in the push toward full coverage for all. Foremost, she and her colleagues asked for a moratorium on Medicaid changes for one year, “while we’re all figuring out how to make this transition.”

“We all have to worry about it because it could be us,” she said. “It all boils down to, ‘Who do I call in the middle of the night when my kid’s got a temperature?’ ”

Jill Caruso, owner

Lockport Apothecary

“The feeling I’m getting from my patients is that their coverage is diminishing and their premiums are going up,” Caruso said. “We have a whole mix of patients, but they are all pretty educated and they’ve been through it where things aren’t covered. They look ahead.

“They have read their booklets. People are choosing their coverage, and they are pretty educated on what their choosing. They call the plan and ask, ‘I’m on these nine drugs, which are covered?’ ”

Caruso said that she doesn’t believe there should be universal health care coverage, which would provide the same benefits for everyone and would be similar to the health coverage in Canada, which some see as flawed. “We have heard of people waiting three months for a doctor’s appointment in Canada. But then, there’re people here who don’t have health care and not seeing a doctor at all, so a three-month wait might be fine with them.”

Caruso noted that New York state — from her vantage point behind the pharmacy counter — seems to be doing a good job with current efforts to reach the uninsured through the Healthy New York plans.

“I’ve got lots of patients using those,” she said.

“I definitely see things that need improving,” she said. “I don’t think we need to go with universal health care. Some people have incredible coverage now. Why would they want universal health care? But the people who have nothing are the ones we should be targeting.”

Frank Maietta

Director of community outreach services

Niagara Falls Memorial Medical Center

Maietta believes education is the first step towards the healing of the nation’s health care system.

“The cure is education, knowledge and access. There so much out there now that people don't realize it,” he said.

The center is involved in a partnership with New York state to reach more people who are uninsured, and then help them get a health care plan. Recently announced efforts include placing an advocate in Niagara Falls schools.

“Their job is to link students and families not only to health insurance but also to primary care,” Maietta said.

There will also be stronger effort to go out into the community, he said. The effort is part of a collaboration between the hospital, state, school district and HealthNOW of Blue Cross and Blue Shield.

“Nobody should not be denied health care because they can't afford to pay for it,” Maietta said.

Dr. Clayburn Booth

General practitioner, Ninth Street ClinicNiagara Falls

When Booth graduated from medical school more than 50 years ago, his father told him something he’d never forget.

“My father told me, ‘Clay, the biggest compliment anyone can pay you is they come to you with their life in their hand and say, ‘Here, doc, take care of it.’ ”

Booth, recently retired after 50 years as a family practitioner in Niagara Falls, still works stints at the outreach clinic on Ninth Street in Niagara Falls, operated by the Niagara Falls Memorial Medical Center, and assists with surgeries at the center and at Mount St. Mary’s Hospital.

“I think the clinic is doing a wonderful thing because no one is turned away,” he said. “What we try to do is take care of these patients as best we can and then to see if we can get some type of insurance for them.”

Both thinks that the government should act on providing health insurance to all.

“I think that somehow our federal government could come up with a plan similar to Social Security,” he said. “I think that people who are working should be able to buy health care through their employer, and those people who aren't working should be able to get it through the government if they don't have a job.”

Contact editor Michele DeLucaat 693-1000, ext. 157.