Tuesday, Nov. 20, 2007

No easy fix for valley health crunch

National problem is amplified by difficult local circumstances

The medical system for the more than 300,000 people who rely on Medi-Cal in the Northern San Joaquin Valley suffers from a multitude of problems that add up to a dysfunctional system: a shortage of doctors, low payments for physicians treating Medi-Cal patients, a high incidence of chronic diseases, poverty and low education rates.

Some of the problems are national in scope: large numbers of uninsured patients, rapidly rising medical costs and a growing elderly population that requires more care.

Because of the complexity of the problem, there's no "magic bullet" solution. Efforts are under way on a variety of fronts, from federal and state medical reform proposals to local efforts to curb costs and reduce chronic disease.

The federal and state proposals are couched in the political arena, as presidential candidates jockey for advantage in primary campaigns, and Gov. Schwarzenegger and legislators battle for constituent groups in California.

Those proposals are focused on the problem of the uninsured. They range from programs that would require uninsured residents to purchase discounted health coverage to universal health care that would eliminate insurance compa- nies in favor of a single-payer, government-administered program.

Each concept has vocal critics.

Labor and consumer groups say requiring residents to buy insurance provides a windfall for insurance companies at the expense of middle-income working families. Republicans and Democrats in the Legislature are battling over how much each stakeholder -- residents, employers and health care providers -- should invest for the coverage.

Insurance companies and conservatives say a government- administered single-payer program would create a huge bureaucracy with rising costs and higher taxes.

The details of the plans are fluid, as legislative negotiations and political campaigns play out.

San Joaquin Valley health care providers and observers watch and hope for relief.

"So far, it's politics," Stanislaus County Chief Executive Officer Rick Robinson said of efforts at reform in Sacramento. "I haven't seen anything with enough substance."

"The solution is not going to be a California solution," added Dr. John Walker, the county's public health officer. "It has to be a national solution. It will require sweeping reform."

"We need a system where everyone is blind to the payer source," said Mike Sullivan, CEO of Golden Valley Health Centers. "A single-payer system would at least be blind. Now, a doctor says, 'What kind of insurance do they have?' and then says, 'Send me the private insurance patients.' "

All of the California proposals have some merit, said Debra Riordan, legislative analyst for the Central Valley Health Policy Institute in Fresno.

"If I had to name one way to solve the problems, it would be some kind of single-payer plan, government-run," she said. "I don't see that happening in the near future. There is a lot of mistrust of government programs."

Riordan said the public struggles with the issues as well.

"We feel people should have access to care. What level of care is under constant discussion. It's difficult. Is it pragmatic, philosophical, ethical? It's difficult for Americans. The Europeans seem to have a handle on it.

"I don't know where it is going. It seems like we are spiraling down still."

Designation means more help

The Stanislaus County Health Services Agency received a federal designation in September that will help keep the doors open at the county clinics. The county's primary care clinics became Federally Qualified Health Centers, which will increase reimbursements for Medi-Cal and Medicare patient visits.