Hospital closures pose threat to public health, and other letters

Regarding the Feb. 23 cover story “Hospitals face closures as 'a new day in healthcare' dawns”, it's a great article. Unfortunately, these closures will eventually place the basic ability to care for our citizens at risk, especially in rapid response to superbugs, Ebola/SARS, natural disasters, terrorism—even plain old age.

Certainly city and county officials have plans for population growth, but most likely do not consider the age-specific chronic diseases and other illnesses that will drive the need for primary-care doctors and hospital beds. Hospitals are needed in our communities but are influenced by the competition of the local marketplace and artificial influences such as government rules and regulations. For example, Medicaid reimbursement rates are unreasonable and absolutely insulting to the healthcare profession. The American Medical Association and the American Hospital Association should be questioning the government's calculations and logic for these absurd payment levels.

Still, healthcare is local. Lakewood, Ohio, one example cited in the story, is in a hospital-rich urban area that is very competitive and finds it nearly impossible to compete financially with the bigger hospitals for reasonable pricing with insurance companies or keeping physicians on staff.

If you believe that healthcare is about choice, guess again. Instead, patients pick from a short list of physicians they get from the insurance company and must go to the hospital directed by the insurance company. If the patient wants to go to a hospital with better quality outcomes, they have to pay for it. Let's change the marketplace, but keep the hospitals open.

Keith W. Gallagher

Former hospital CEOCooper City, Fla.

I read the editorial “Round 2: No win for the ACA” with some delight in witnessing that the author is just now beginning to take off his rose-colored glasses when describing the Affordable Care Act.

I have done research on the impact of the ACA on healthcare as it relates to the hospital that I lead in South Dakota. “Zero, zilch, nada” is the impact of the ACA on this hospital. If anything, the ACA has hurt us with the rise of high-deductible health plans and the illusion of being insured while not having a plan that pays. We all know the drill: A working-poor farm family shops for price and ends up with a high-deductible plan. The patient faces expensive medical costs, and then there's that high deductible to meet, something the family isn't prepared for. Consequently, the hospital gets stuck with another unpaid bill. Yes, these people are technically insured, but we see no cash coming in from many of them.

Although I and the South Dakota Association of Healthcare Organizations support Medicaid expansion in our state, I recognize that South Dakota is solvent partially because it controls spending, just like all families have to do. In defense of the lawmakers' decision not to expand Medicaid, with the federal deficit at $18.3 trillion and no end in sight, just how inclined is any realistic state to trust the promises being made?

If the president is going to salvage the ACA, which does have some good components, he had best heed the recommendation made near the end of the editorial. He must find a way to persuade me and those like me who see no benefit in the law. We need to be convinced that we, too, are better off.

Jay Jahnig

CEO/administratorFaulkton (S.D.) Area Medical Center

Regarding the article “CMS pitches 1.1% boost to Medicare Advantage payments”, anyone selling Medicare Advantage plans would not be surprised that risk scores for Advantage plan members trend higher. Advantage plans tend to serve lower-income beneficiaries, those in urban areas, those with chronic needs and institutionalized patients. The plans serve these populations well and provide a quality of care that would often be unavailable to them otherwise.

To compare the cost of those plans to original Medicare reveals very little and ignores the value actually delivered to members of Advantage plans.

It is extremely short-sighted for the political class to continue to undercut the Advantage program. They do so based on the misguided belief that insurance companies with the audacity to show a profit in this challenging market must be punished, even if at the expense of the populations they serve.

Dave Gardner

Crofton, Md.