Positive marks

Todd Gallati

The health care reform legislation recently signed by President Barack Obama remains unpopular with the majority of Americans, polls show, but several Charleston area health care providers are cautiously optimistic about the change.

While they acknowledge that the future costs of the reform are unclear, they are more certain about its potential to improve the health of their patients in the short term.

But they also have questions and concerns.

The hospital administrator

From Todd Gallati's perspective, the federal government mandated universal health care years ago, when President Ronald Reagan signed a law requiring emergency rooms to treat all patients who show up there.

Gallati, president and chief executive officer of Trident Health System, said about one of every five patients who arrive at Trident's emergency room currently don't have insurance.

It costs the for-profit hospital system about $25 million a year, or about one-fifth of its $125 million payroll.

"That's a pretty significant amount at the end of the day," he said.

Gallati noted that the legislation promises to extend health care to about 32 million more Americans, and that would help not just his emergency room but also those newly insured. "It's clear that folks without health care insurance have worse health care outcomes."

"Of course, the big concern we all have is how you pay for that," he said.

Hospitals have agreed to take a reduction in payments from federal Medicaid and Medicare programs because they expect more of their patients will arrive with private insurance. "The key question is how is that going to balance out," he said.

The doctor

Bill Moran, who runs the Medical University of South Carolina's division of internal medicine and geriatrics, thinks about how the new law will help two women he knows by expanding insurance coverage for them.

One is currently a patient who works for a large company but badly wants to start her own business. She has severe asthma and currently cannot expect to get health insurance on her own because of that condition.

Moran said he also thinks of the woman who empties his trash can each night. She works two jobs, but neither offers insurance. She has a pre-existing condition, so health care insurance likely would cost about twice what she brings home in pay.

"She works at MUSC and can't get access to MUSC's great services because she doesn't have insurance," he said, adding that both women should be incredibly helped by the new law over the next few years.

Also, he noted that the average black male in South Carolina lives five or six years less than state residents as a whole, "and not a small amount of that is because of chronic illness they can't get under control because of (limited) access to care."

Moran also said the bill has measures to improve the quality of health care, but these have been less talked about. "We will all start getting feedback on our performance," he said. "We're going to be held to higher and higher quality standards. It's really important."

The nursing educator

Gail Stuart expects health care reform to make her job busier.

As dean of MUSC's College of Nursing, she oversees an operation that graduates 120 baccalaureate nurses each year and has 180 graduate nurses working on more advanced training.

Nurses will be at the forefront of meeting the new demand created by more insured, "and the projections are nationally that every (nursing) school will need to double," she said.

The problem is that state budget cuts have left MUSC with no money to hire instructors and accept more students.

"It's really a double bind that we're in right now," she said. "We are turning away qualified applicants here at MUSC for all levels of programs."

Stuart said she's encouraged by changes in the law that will encourage hospitals to create one-stop shopping for mental and physical illnesses "A lot of depression is so commingled with so many of the chronic illnesses," she said.

And she hopes the added focus on prevention will pay off too.

Moran agreed, adding, "U.S. health care is like a winding mountain road with no guard rails, but a whole lot of ambulances parked at the bottom."

The med student

Vandy Gaffney, a fourth-year MUSC medical student from Orangeburg, said he watched the congressional health debate unfold on C-SPAN along with several fellow med students, pizza and popcorn.

"It was real reality TV, if you will," he said. "It was a sigh of relief among those who I was around. We can actually see there is some progress and some changes being made. Whether they're the end-all, be-all, I think everyone in this room agrees that is not the case, but this is a very fundamental step toward changing a system that needed to be changed."

While Gaffney plans to focus on orthopedic surgery, a relatively lucrative field, he said the new law will provide more encouragement for students going into general practice.

For instance, the bill restores the defunct National Health Service Corps that will take away school debts for students who go into primary care and practice in areas that need doctors.

"I know several (classmates) who are pretty thrilled with the fact that they can get some of their student loan money taken away even during residency because they'll be working in an under-served area," Gaffney said.

Moran said doctors focusing on general internal medicine and family medicine are retiring faster than they are being replaced, largely because reimbursement for them is relatively poorer.

"Vandy's starting salary will be higher than mine at retirement, after 30 years of practicing medicine," Moran said. "That's crazy. That's insane, but that's how bad this has gotten."

"Doctors make enough money, but it's hard to compete on a market-based strategy to get good people like Vandy to come into internal medicine or geriatrics," he added.

"The challenge is the complexity of frail older folks. We have fewer and fewer docs for more and more patients," he said.