The following column is the opinion and analysis of the writer.
In his Aug. 22 op-ed, Dr. TK Kelly, an emergency medical MD, appropriately stressed the problems rural residents encounter when requiring emergency medical services. During my career, I served for some 28 years as a CFO in three major metropolitan teaching hospitals; a Medicare provider appeals judge and agency chairman appointed by the secretary of health and human services; and the founding director of finance for the Hospital Association of New York State (HANYS).
In that HANYS job, I periodically conferred with health-care financial executives from most other states. They would kid me when the topic of rural hospital concerns arose that I didn’t have to listen. I reminded them that I represented more than 100 rural hospitals — not just Big Apple hospitals — and that I had vital concerns about those isolated but essential health facilities.
While the headline for the Kelly op-ed related to a funding crisis for air medical services, his essay also cited the long-standing financial plight of small rural hospitals across America which often provide lifesaving emergency medical and maternal care for farmers and ranchers and their families and employees. Those individuals often lack adequate health insurance to pay for their care and/or air transportation in dire emergencies. Even if they have insurance, those programs rarely reimburse the costs of their service and place financial burdens on hospitals and air medical providers that threaten their survival.
Kelly observed that, in the past nine years, 102 rural hospitals across America closed, and three of those were in Arizona. Kelly affirmed, “access to health care in rural America is disappearing.” My experience with HANYS in the early 1970s and since then validates Kelly’s observation and proves that the plight of rural hospitals has plagued America for more than 40 years.
Congress long ago recognized that rural health-care access and financial survival problem years ago as it enacted laws to tweak Medicare rural hospital reimbursement. Congressional actions consistently have proven to be inadequate to solve the problem because of the arcane black-box algorithms that underlie Medicare reimbursement rules.
During the experiences of my career in health care, which emphasized the costs of health care and how to cover them while providing those who need access to quality health services and with a variety of health-care funding mechanisms, I long ago concluded that America would not be able to effectively cope with the need to provide adequate access to quality care for all Americans until it scrapped its fragmented insurance and medical financing methods and adopted a single-payer insurance system (like a version of Medicare for All). The cost of covering everybody would be met by substantially reducing administrative expenses (the arcane coding and billing systems are virtually a total waste), by eliminating health-care and insurance advertising expenses, by eliminating profits, and by eliminating the obscenely exorbitant levels of compensation paid to health-care and insurance executives.
Enough studies have proven that America will be able to meet its health-care needs under a single-payer program while reducing total costs (premiums, copayments, deductibles, etc.) to every American.
That thesis also has been proven by the actual experiences of the world’s leading nations, which incur lower costs and better health-care outcomes than the U.S. to provide access to adequate health-care services not only to every resident but also, in many cases, to every visitor.
Paul Morton Ganeles is a retired CPA; chairman of the PRRB, USDHHS; director of health finance, HANYS; CFO of Grady Memorial Hospital in Atlanta; Hospital of St. Raphael in New Haven, Conn.; Lenox Hill Hospital in New York City.