published Wednesday, May 26th, 2010

Panelists balance worry and hope over health reform


by Emily Bregel

Despite deep concerns about how health care reform will actually be implemented and financed, the CEO of the state's largest health insurer said Tuesday she is "somewhat optimistic" about the overhaul.

After 35 years in the health care field, "I'm ready for something to change here," said Vicky Gregg, CEO of BlueCross BlueShield of Tennessee.

"You feel like you have been working all your career trying to make sure people get coverage, get care, and you keep in some ways, beating your head against a wall," she said, speaking during a health care forum sponsored by the American Society of Women Accountants' local chapter. "My hope is that this bill is disruptive enough that it really opens up some of those opportunities" to improve cost and care.

Two months after the passage of the controversial health care reform bill, a panel of three local speakers representing health insurers, hospitals and physicians expressed both hope and trepidation about reform's outlook Tuesday during the luncheon at the Chattanoogan hotel.

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    Staff Photo by Allison Kwesell/Chattanooga Times Free Press - Erlanger CEO Jim Brexler (left), BlueCross CEO Vicky Gregg (center) listen as UTC Accounting professor, Greg Thibadoux (right) speaks during a health care reform forum sponsored by the American Society of Women Accountants at the Chattanoogan.

Erlanger hospital president and CEO Jim Brexler said that, at the outset of the reform debate, there was broad consensus on many principles of reform, such as the need for greater efficiency and more rational incentives for providers.

Under the current system, "if we keep you well, I don't have a job," he said. "We need to move toward a focus around wellness, education, prevention."

Local medical oncologist Dr. B.W. Ruffner, president of the Tennessee Medical Association, said he does not believe health reform tackles the major problem of skyrocketing medical spending and he worries doctors will be restricted in their decision-making by cost concerns under reform measures.

Still, he said he sees potential for health insurance exchanges to make insurance more affordable. The exchanges will be set up at the state level for individuals and small businesses, who can pool together in a large group to purchase private health plans.

"I think (they) actually drift us toward a German-type system," he said. "I think that might have some downward pressure on (medical) inflation."

In response to one audience-submitted question about whether Americans overuse the medical system, Dr. Ruffner said, "Uh, yes. Next question," to audience laughter.

Ms. Gregg added that another factor in ballooning health expenditures in the United States is the price tag on drugs, medical devices and services in the country, relative to other countries.

"I think there's a reality here that we are going to have to face. Some of it is inefficiency ... but some of it is also that the United States really does fund innovation for the world," she said. "In a global economy, we really have to begin to ask the question of whether or not we can continue to do that."



THEY SAID IT

"I'm ready for something to change here." -- Vicky Gregg, CEO of BlueCross BlueShield of Tennessee



"We spend more money at the end of life because families and society hasn't come to a realization ... that we have an end somewhere in our life cycle, and so we spend exorbitant amounts of money in intensive care units and not necessarily for quality of life, just for continuance of life." -- Jim Brexler, president and CEO, Erlanger hospital



"Physicians are not going to like it (some reform measures) because the first rule of medicine, the dream of every physician, is autonomy." -- B.W. Ruffner, medical oncologist

Continue reading by following these links to related stories:

Article: Chattanooga: Panelists balance hope, worry over health reform

Article: Feds ask Virginia health reform lawsuit be dismissed

about Emily Bregel...

Health care reporter Emily Bregel has worked at the Chattanooga Times Free Press since July 2006. She previously covered banking and wrote for the Life section. Emily, a native of Baltimore, Md., earned a bachelor’s degree in American Studies from Columbia University. She received a first-place award for feature writing from the East Tennessee Society of Professional Journalists’ Golden Press Card Contest for a 2009 article about a boy with a congenital heart defect. She ...

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Vicky Gregg stated "You feel like you have been working all your career trying to make sure people get coverage, get care, and you keep in some ways, beating your head against a wall."

Pardon our skepticism, but Blue Cross has been one of the foremost providers denying care, even to folks with terminal diseases. Maybe Ms. Gregg was one of the few battling an uphill battle within her organization, but there comes a day when we should question what is it we are really doing? Are we part of a company that behaves ethically and morally, for the human good? Or not.

The panel should have included a broader range of 'experts', including those who have been at both the receiving and the giving ends of healthcare. This panel doesn't seem to be really knowledgeable about the long term implications of the Monster Pelosi, Obama and Reid pushed through the House-illegally and unconstitutionally. That in itself shouts BIAS and the need for more objectivity. Or perhaps, the reporting here fell alittle short of fairly delineating both sides of the issue.

May 26, 2010 at 8:37 a.m.
princehal said...

"We spend more money at the end of life because families and society hasn't come to a realization ... that we have an end somewhere in our life cycle, and so we spend exorbitant amounts of money in intensive care units and not necessarily for quality of life, just for continuance of life." -- Jim Brexler, president and CEO, Erlanger hospital

                      §§§§§§§§

Yes, Mr. Brexler, we do spend exorbitant amounts of money to prolong life; won't you do the same when your time comes? We spend so much money - sometimes more than a million dollars - to bring premature children into the world. It only seems just to extend to someone the same resources for hope and comfort, when exiting this life.

May 26, 2010 at 9:47 a.m.
easyeintn said...

"Pardon our skepticism, but Blue Cross has been one of the foremost providers denying care, even to folks with terminal diseases. Maybe Ms. Gregg was one of the few battling an uphill battle within her organization, but there comes a day when we should question what is it we are really doing? Are we part of a company that behaves ethically and morally, for the human good? Or not."

Unfortunately, everything we hear on TV isn't always true. Canary - Blue Cross has been one of the foremost providers denying care? Do you have any statistics to support that statement? Last I checked, insurance companies do not provide health care, so I do not believe they are able to deny care. I do know that health claims may be denied, but I do not think Blue Cross is blocking any hospital doors to prevent people from receiving needed health care. Also, last time I checked, insurance companies and members agree on a contract, which is signed, that clearly details what policies cover and what they do not. If an insurance company says up front that a service will not be covered, why are they all of a sudden wrong when they deny the services they said would not be covered from the beginning?

Also, you feel that it is ethical for the insurance company to pay for illnesses which are terminal. If that person has coverage, I completely agree. But also as an insurance policy holder, I do not want to see my premiums sky rocket through the roof because someone takes out an insurance policy on the way to the hospital because of that terminal illness. Without restrictions on coverage, anyone can get an insurance policy at any time, sick or healthy, and some of those people are going to have huge doctor bills. Do you know who pays for those huge bills? Everyone else who has the same insurance. Insurance companies are not going to operate at a loss because we believe its unethical if they don't pay everyone's bills. Those high costs get passed on to the members through their premium prices. It seems to me that Ms Gregg is wanting to find ways to lower heath care costs, which keeps all of her customers premiums as low as possible. I completely agree that there are very sad and unfortunate situations when it comes to health care. Something does need to be fixed. Someone should not have to live a life in debt because they got sick and now owe thousands and thousands of dollars in medical bills. But if the answer is making sure the insurance company covers every sick individual and pays for every insurance claim, then I assume you will be the first to volunteer a larger part of your paycheck for the premiums that pay those claims.

If you think health care is expensive now, wait until its free. Thanks for letting me stand on my soap box for a few minutes.

May 26, 2010 at 7:11 p.m.

That's okay, easy. I think you misunderstood my post and are not familiar with my stance on "free" healthcare as I have explained in many postings on this site. I believe in the Pure & Free Enterprise System and the Constitution's mandates for keeping the Gov't out of our business and businesses as much as possible. Having lived decades with nationalized/socialized HC, I know more than most who post here just what the dangers and pitfalls are with Gov't provided HC.

I have lived in a Liberal-Left State(s) with a varied amount of HC Providers, so you need not nitpick at my words. Why do you assume like the Leftists who post here that the only source of my knowledge is TV? You are very wrong on that one. I was not raised to be nor am I a mindless sycophant of the media and the Internet like many here are.

You know what I was referring to when I spoke of Blue Cross and HC insurance. I have many friends and co-workers who had/have Blue Cross, Health Net, Cigna, etc. and some became very ill or were diagnosed with a terminal disease, usually cancer. Blue Cross was at the forefront of lawsuits for 'dropping' their insurance and they were prevented from getting insurance from a more expensive company. The costs were too prohibitive. Some have to get an attorney to help them get their insurance back. The stress caused by some HMO's is unfathomable, especially when the patient has been paying into the 'system' for years.

You may be a BC employee or CEO, I have no idea. But you sound intelligent, so I suggest you do your homework outside of TN and look at the stats, if its stats you want, to determine just how many patients have 'lost' their coverage due to their care being too expensive for the Provider's liking-or so they say. I know both sides of the story and the abuses, but making out that our HMO's and PPO's are without culpability is dishonest and frankly, very biased.

May 26, 2010 at 7:55 p.m.
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