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Glimpse of the Future - Healthcare Access

On January 17-18 I had the privilege of attending the "Conference on Health Care Access 2003” presented by the Health Professions Division of Nova Southeastern University in Ft. Lauderdale. This cutting edge conference promised, in its second year, to stimulate discussion and thoughtful contemplation of access to the health care system.

The first day of the conference consisted of a Community Forum. The major panelists included: Sen. Ron Klein, Democratic Leader, Florida Senate; Rep. Eleanor Sobel, Member, Florida House Health Care Committee; Sen. Campbell, Florida Senate, and three NSU faculty members.

Each panelist was given about ten minutes to make their presentation to the group on their opinion of the state of access to health care in Florida and the issues facing us, and what they felt the solutions might be. In keeping with such discussion, each presenter discussed the issues with bias in favor of their own groups’ position and agenda. The discussion was then open to the audience for questions. In attendance were approximately 250 people including health care students, faculty, senior citizens, and other concerned people including physicians, pharmacists, health care administrators, physician assistants, nurses, and representatives of the major health care groups in Florida. Additionally several members of the legal community were in attendance and participated.

The main questions addressed in the forum centered on the malpractice crisis issue, cost of medications, health insurance plans, veteran's problems, and special care programs provided by the state. There were some rather emotional pleas for help for various groups. In addition, there was one emotional exchange between one of the legislators and a hospital administrator over a malpractice issue. It became a bit emotional and personal. The moderator admonished the group and directed them to keep things on a professional basis and reminded the participants that we were there to share ideas and not place blame on any one particular group. One interesting fact I was left with from the open discussion was the commentary that there are 108,000 drivers in Florida over the age of ninety. Think about that the next time you get behind the wheel in Florida. With as many senior citizen drivers in Florida, they constitute a major voting block for consideration in any political discussion.

The second day began with a plenary session with presentations basically on the same issues but on a national basis. The major panelists included: Yank Coble, M.D., President, American Medical Association; Mary Alexander, J.D., M.P.H., President, Association of Trial Lawyers of America; William Novelli, Executive Director & CEO of the AARP and George Atkins, Managing Director, State Affairs, American Association of Health Plans.

The second day began with a plenary session with presentations basically on the same issues but on a national basis. The major panelists included: Yank Coble, M.D., President, American Medical Association; Mary Alexander, J.D., M.P.H., President, Association of Trial Lawyers of America; William Novelli, Executive Director & CEO of the AARP and George Atkins, Managing Director, State Affairs, American Association of Health Plans.

Each of the second day panelists presented their views on the health care situation in America and attempted to relate it to Florida. A couple of facts given that stood out were: 1) There are 43-46 million Americans with no insurance coverage at all; and 2) Sixty percent of Florida physicians are over 50 years of age, and forty percent are greater than 60 years of age, so the physician population in Florida is an aging one which is going to have a tremendous effect on access to health care in the next five to ten years especially.

Each group representative seemed to blame one of the other groups for their part in the health care access and liability crisis. And no one had anything good to say about the insurance companies and their perceived "greed” and mismanagement of funds and their role in the current crisis. Again, the tension between the lawyers and physicians was quite evident. The rhetoric was quite inflammatory at times and it was really interesting to watch the volatile exchange. There was no give and take, mostly just each "giving it" to the others and blame shifting. No one appeared to be in a compromising mood on this day. The exchanges were emotionally charged and personal in many ways.

The second part of the morning plenary session dealt with the same issues on a state perspective. The panelists for this discussion included: Joel Rose, D.O., President, Florida Osteopathic Medical Association (FOMA); Howard Coker, President, Academy of Florida Trial Lawyers; Frank Sacco, J.D., CEO, Memorial Healthcare System; Bentley Lipscomb, Executive Director, AARP, Florida Chapter; and Harry Spring, Director, Governmental Relations, Humana.

This was more of the same discussion and commentary as had transpired in the earlier session, but clearly shifted the focus more on Florida. Again there was a great deal of finger pointing and accusations about the cause of the problems. Each person and/or group pointing at the other. Most everyone was pointing at the lawyers and the insurance companies as the major culprits in the hot issue of medical liability, cost of access to care and tort reform efforts. I came away with a better understanding of the "caps” proposal and the differences in economic damages and those for pain and suffering. The big question for the audience was how the insurance companies can justify paying their top executives thirty million plus a year in salary and benefits and then raising the rates for malpractice, and health care coverage.

The luncheon event and function featured speaker Sen. Jim King, President of the Florida Senate. He, the Governor, and Rep. Johnny Byrd, Speaker of the House, are probably the three most influential persons in Tallahassee this year. If President King does not want legislation on this issue to be heard in the Senate, it is likely that it will not be heard. The same can be said for Speaker Byrd in the House. And surprisingly, the comments by Sen. King would lead one to believe that the Governor appears to be of questionable influence at this time on this issue.

Sen. King presented his views in stereotypical, Southern politician form. However if one listened closely, it became apparent that he is well informed, very bright, intelligent and knowledgeable on the issues. His discussion was a very entertaining presentation filled with Southern anecdotes. His key point was that there is going to be a $2-4 billion dollar budget deficit this year, and that the budget problem is going to be the focus of the legislature, not the alleged malpractice issue and tort reform. He indicated that a decision on this issue is not likely this year unless there is some major breakthrough in partisan politics. "They may listen but they won't pass any tort reform", was his message. This did not sit well with the physicians and other medical professionals in attendance. I recall that the physician representatives pointed out on several occasions during the conference that it took a three and one half week strike by doctors in California to get any legislation passed.

The afternoon sessions focused on malpractice, universal health care, care for the homeless and illegal alien use of health care, the high cost of prescription drugs, and terrorism and weapons of mass destruction. I attended the medical malpractice issue session and the session on terrorism. The session on malpractice had some good information presented by Dr. Rose of FOMA and Dr. Palamara from the Florida Medical Association. The lawyers did their best to counter the physician presentation comments and arguments. The lawyers indicated that the "caps" legislation in California has not stopped the rise in malpractice insurance rates or had a tremendous on the number of lawsuits filed, or the size of the judgments rendered.

The session on terrorism was very informative and frightening. It was presented by Dr. Robin McFee, and Charles Lewis, PA-C from Nova Southeastern University. Nova is the first medical school in the nation to require mandatory training in the medical aspects of bioterrorism, and hands on decontamination drills and training. They voiced some opinion on the recent Norwalk virus outbreaks aboard the cruise lines and how they were more than just coincidence but more likely some unknown group testing the feasibility of such an attack. They also talked about the feasibility of dirty nuclear bombs. It was, needless to say, an eye-opening and thought provoking presentation.

During the breaks the conference participants were able to talk informally and network with the representatives of the various groups in attendance. I think this was a valuable experience for all who attended. I believe that professional medical organizations, such as the Florida Academy of Physician Assistants, should continue to have significant representation present at such conferences whenever given the opportunity. Health care is a business,...a big business. Like it or not, due to the economics and complexity of the situation, it is also very much a political environment. Groups that are regulated by state and federal law, and the legislators of those jurisdictions, must learn to "play" the political game and play it well. There is an old saying that tells us to "keep your friends close, and your enemies closer” and learning that will help keep our professions respected and viable entities in today's world of health care.

On January 17-18 I had the privilege of attending the "Conference on Health Care Access 2003” presented by the Health Professions Division of Nova Southeastern University in Ft. Lauderdale. This cutting edge conference promised, in its second year, to stimulate discussion and thoughtful contemplation of access to the health care system.

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