Health Reform and Public Service

The world became a lesser place on Friday, August 28.  My mother-in-law died. I had known her for 41 years and never once heard her speak a cross word.  She died three months short of her birthday. She would have been 90 years old. She worked her entire professional life in public service. Her first position was as a Head Start teacher in the first year of the Head Start Program in Alabama at the time of the Selma march. Her major role, once she returned to Iowa, was as a county home economist, initially in Kossuth County, then for over 20 years in Crawford County. She added Ida County toward the end of her career. She taught rural families how to survive and thrive in the changing world of the 1960s, 70s, and into the 1980s. At her retirement dinner, her supervisor said, “In many ways, Norma has been in the vanguard.  When you look to see what Norma is doing and in two or three years, all Iowa counties will be doing it.”

On August 17, Iowa announced the four for-profit managed care companies that will manage the health care for 550,000 Iowans for a cost of several billion dollars over the terms of the contracts. Each one of the companies awarded an Iowa contract has a checkered past in other states where they have been responsible to provide appropriate and adequate  health care for poor, disabled and elder people and have been charged with the abuse of people receiving Medicaid. I have written several posts regarding my concern for this venture.

Since those blog posts, we have learned that every one of these companies has been charged with abuses involving their care of Medicaid patients in other states. With their profits, these companies have donated to the political campaigns of elected officials in Iowa who have and will decide the fate of these same companies. Finally, one of these companies hired a former Medicaid consultant shortly after that person had ceased working for Iowa Medicaid. A coincidence?

On Monday, August 31, the Medicaid Assistance Advisory Council met at 10 am. Comprised of professional representatives and consumers, this council will provide feedback and analysis of the managed care companies in Iowa. I propose that we change the name of the council to the Medicaid Oversight Committee. My fears for this effort would be much less if I thought that such a committee would have the necessary authority, resources, and enthusiasm to fulfill the new title.

I also note last week’s announcement from Tyson Foods that it would close the beef packing plant in my hometown of Denison, which is where my mother-in-law worked for over 20 years. This plant started as Iowa Beef Packers, a pioneer company in creating boxed meat. The company would become the largest beef packing operation in the world. It has special meaning for me because I worked at the plant for two summers and during two Christmas breaks. I would not be a physician today if I had not worked in various roles that allowed me exposure to blood products in such a way that prepared me for medical school.  Four hundred people will lose their jobs because of this closure.

For-profit companies make money. It is their singular mission; public servants improve the lives of the public. It is their singular mission.

This week, one of my Medicare Advantage patients was admitted to the hospital for loss of consciousness. My patient had multiple medical problems as well as social issues to deal with.  Despite help from a nephrologist, the patient has been in the hospital several times. I had known the patient for many years and knew he needed several days in the hospital to sort out his medical problems, but his for-profit Medicare Advantage company was badgering me to place him on observation status which would force him pay for his medications while in the hospital. This badgering was occurring at a time when his potassium was severely low and upon standing, his blood pressure, and oxygen status were also severely low. This company is one of the companies that received an Iowa Medicaid managed care contract.

For years, I believe family physicians in Iowa have been public servants for taking care of Medicaid patients. The fees we received were extremely reduced to the point that we were often losing money in the process of caring for these patients. We did this public service because we knew it was for the greater good of Iowans.  My question is whether the public service dedication of these family physicians will be equally high when we know that the money saved is going directly to profit these managed care companies.

Finally, the audio tapes from Planned Parenthood leaders’ discussions regarding monetary arrangements for fetal tissue have raised concerns. For individuals with such concerns, based on the previous track records of these managed care companies, I guarantee that the health of Medicaid recipients will suffer at some time due to the for-profit interests of these Medicaid managed companies.

I go back to public servants like my mother-in-law who work their entire lives with their total dedication to the betterment of our fellow Iowans. To my mother-in-law and to all those like her, I sincerely thank you for your service on behalf of others.