In addition to the many comments made by Howard Regional Health System CEO Jim Alender concerning health care reform that ran in the print edition of this week’s Kokomo Perspective, the hospital administrator had more opinions to share on key issues in the reform debate — tort reform and access to health care.

Tort reform is the current buzzword for Republicans in the House and Senate, with many threatening to vote against any health care reform measure that does not contain an overhaul of the legal system as it pertains to the medical industry. And Alender is a supporter of tort reform. However, he explained that the measure may not have the effect the politicians expect.

Alender said he recently sat on a panel of hospital officials around the state to discuss the matter, and the opinion offered was that tort reform won’t translate into cost savings for taxpayers.

“I’m not of this opinion, though it was the opinion of other CEOs and physicians that strengthening tort reform still won’t offset the cost of defensive medicine,” said Alender. “There still will be a defensive cost. The reasoning is no physician wants to get sued. They will still order tests. It will help, but it won’t reduce it.”

An example of how tort reform might not be the magic pill politicians hope it would be can be found in the recent advisories concerning cervical and breast cancer screenings. During the week of Nov. 16, the U.S. Preventative Services Task Force issued findings that showed breast cancer screenings were unnecessary before the age of 50, and were only needed every other year from ages 50-74. That same week, the American College of Obstetricians and Gynecologists announced that pap tests for cervical cancer were unnecessary for women under age 21, and only needed every other year from ages 21-30.

The American Medical Association quickly acted to dismiss the findings and urged the public to continue following previous guidelines. That move, contrary to the scientific research that was presented, could be attributed at least in part to the current risk of malpractice suits should cancer go undetected.

However, a second outcry in response to the findings might be an indication that tort reform won’t mean a desired reduction in the annual cost of defensive medicine, which has been estimated by the administration of former President George W. Bush and the American Academy of Orthopaedic Surgeons to be anywhere from $60-$175 billion.

The general public dismissed the findings as well, citing concerns that a lack of testing somehow would result in risk. The American people appear to have become accustomed to medical testing and don’t see it as defensive medicine. With that mindset present, testing will be requested and perhaps even demanded, regardless of what reforms are enacted.

The other major hurdle Alender sees standing in the way of effective health care reform is access from the supply side of the equation. He stated that there are not enough physicians available to handle the load of a national health care program.

“It’s the right thing to do to give all the people insurance, but you also have to address the supply side of the issue,” said Alender. “We’re not doing that. We cap the amount of people in primary care. Only half of new doctors are enrolling in primary care, so who is going to take these people?

“You can put another 8,000-10,000 people locally in a government plan. The problem is, if (government) is going to reimburse at Medicaid rates, no physician wants it. That’s 30 cents on the dollar of costs. Why would you want to add another 50 patients to your practice where you’re not even covering costs?

“The thing people don’t understand is you get a letter from the government telling you that you’re insured. You aren’t feeling well, so you figure since you don’t have to pay, you’ll go to the doctor. But you can’t get in, so you go to the emergency room to the highest cost health care.

“Our employed physicians have to take Medicaid, even our specialists. As a not-for-profit, we have to do that. But the independent physicians don’t have to take it. If everyone took 10-12 percent, there wouldn’t be a disproportional amount of burden on those who take Medicaid.

“But that’s Pollyanna stuff. There is no incentive. They have to pay their rent, their office staff, their supplies. If for every dollar of service I provide, I only get 35-50 cents back, I don’t provide that service. The other side of it is, those who do take Medicaid can only take so many patients or we go broke. You have to have reform to provide a supply of physicians to care for the patients. It’s one thing to give people access to care. It’s another to not have the ability to find someone to provide it. The current bills do not address this.”