2009-09-23 / Features

Chamber's Health Town Hall Finds More Questions Than Answers


Caryn Schwab, Mount Sinai Hospital of Queens executive director, was a panelist at the Queens Chamber of Commerce emergency town hall meeting on health care in Queens September 16. Photos Dan Miller/DMD Images Caryn Schwab, Mount Sinai Hospital of Queens executive director, was a panelist at the Queens Chamber of Commerce emergency town hall meeting on health care in Queens September 16. Photos Dan Miller/DMD Images On September 16, the day when the first of the proposed healthcare legislative bills was introduced in the United States Senate, the Queens Chamber of Commerce held a meeting to address what it termed the healthcare emergency. Opening the meeting, QCC President Albert F. Pennisi described health care as "the number one priority" among Queens Chamber of Commerce members. At the Bulova Corporate Center in East Elmhurst, a fivemember panel comprising two doctors, two healthcare administrators and a businessman met under QCC auspices to discuss insurance as one of many expenses. Former Asemblymember Ivan Lafayette, now state Insurance Department Deputy Superintendent for Community Affairs, was a last-minute addition to the panel.

The panel's discussion and the audience's subsequent questions were quite civil, but disagreement was as apparent at this meeting. Each panel member brought some enlightenment to the audience at one point or another, and each audience member who spoke showed an awareness of complexities that lie beyond fervent beliefs about free markets or the single payer system.

Parker Jewish Institute President and CEO Michael Rosenblut told panel members and the audience that he finds little concern for senior citizens in current legislative proposals. Parker Jewish Institute President and CEO Michael Rosenblut told panel members and the audience that he finds little concern for senior citizens in current legislative proposals. First of the panelists to speak was Kenneth J. Buettner, president of York Scaffold Equipment Corp. and an official of both the Queens Chamber and the Long Island City Business Development Corporation. He spoke as a member of the construction industry, which has higher expenses than most. He said that until recently, liability insurance was his highest insurance expense, followed by workmens' compensation and health insurance. The latter two have now exchanged places, health insurance topping workmens' comp. Since he maintains an average expense of $20,000 per employee, Buettner said he is "certainly looking for some sort of relief out of Washington". But, he said, though help is needed, what help might government provide? His is a union work force; if minimal health insurance becomes available to both unionized and non-union construction companies, the unions will find the appeal of its health benefits undermined.

The next speaker was Alvin Eden, M.D., a pediatrician who, being also father of an obstetrician, could speak to a number of doctors' concerns. Though there are several generations of doctors in his family, there is, he maintained, a coming shortage of physicians. Add that to what he called the current absurdity of doctor distribution and he could foresee a future where parts of the country would be begging for medical care while other parts were overloaded with it. He said he favored the public option, i.e., a segment of general health care that is government-run, but spoke of a service it could fulfill that wouldn't occur to most people. He said that the need for primary care physicians is particularly acute, and that many of them are produced by the so-called international medical schools. American students at these schools cannot get student loans, as they could in the U.S.; he proposed such loans be available under the public option. But, he believes, the most serious problem facing physicians is tort reform. Before doctors can favor any healthcare plan, malpractice suits and jury awards must be brought under control, he said.

Eden was followed by Terry Golash, M.D., medical director for Aetna Insurance in the New York area. One topic he covered was: Should the "pre-existing conditions" his company and others sometimes declare to deny coverage be abolished? Such reform would assume nothing unusually expensive ever occurs, when it's obvious it does occur, he said. What of the uninsured, popularly numbered at 47 million? He said that among them are 12 million who could be on Medicaid but aren't, and nine million who feel no need for insurance. He went so far as to question the latter's "free choice", saying that perhaps medical insurance should be as compulsory as automobile insurance, though applying in this case to everyone. As someone working for a large insurer, he nevertheless expressed shock at the price of health care, reflected in the size of premiums. He defended Aetna and other insurers as being more regulated than any other industries. But, he asked rhetorically, can anything be done about the shocking situation? "If we can spread the costs around," he said hopefully, "maybe we can move this mountain."

Mount Sinai Hospital of Queens Executive Director Caryn Schwab was quick to agree that health insurance should be compulsory. The fourth of the panelists, speaking as one who, in a career nearly 30 years long, has been a healthcare administrator in New York City government and two of the city's largest hospitals, Schwab said it would help spread the burden of expense. As it is now, as she knows well, costs in hospitals are rising faster than nearly anywhere else.

As executive director at Mount Sinai Hospital of Queens, Schwab has been eyewitness to both the rise in costs and the disappearance of hospitals (St. John's, Parkway and others) that have closed within a few miles of hers in the borough. At the same time, some patients who should be released are held too long in hospital because the right postoperative care for them can't be determined. And though they are at the moment an explosive topic in the healthcare debate, illegal aliens, she said, are a large and unavoidable part of emergency care, and their numbers will grow. She said an additional revenue stream is needed, and brought up the topic of taxation, which she said would have to be extended in all directions, particularly on high-end "Cadillac plans". Though she believes that tort reform and malpractice relief are not going to come as fast as Eden wishes, she did conclude that healthcare reform "is going to require that we change the way we practice medicine".

The final panel speaker was Michael Rosenblut, president and CEO of Parker Jewish Institute, a health care and rehabilitation center for older adults located on Long Island, in New Hyde Park. His advocacy of the elderly led him to say that he finds little concern for them in all the current legislative proposals. Such disregard is nothing new for him: he said that he and fellow board members at Parker agreed some time ago that kidney dialysis treatment, of prime concern in the care of the aged, was so lacking in the local healthcare facilities they had to do something about it, and were thus moved to raise the money for a $4 million dialysis center that is soon to be opened. But government administrators and legislators, faced with rising

Medicare and Medicaid costs, are doing nothing more than reducing coverage in small ways and lowering reimbursement rates—a maddening nickeland dime procedure, he said.

During the question period, one woman said there are too many issues to cover. While agreeing, Golash said that all the crucial points must be covered; selectivity would cause further imbalance. Another woman said that travel in Scandinavia, combined with her observation of middle class women's discomfiture upon losing work and benefits while not being eligible for Medicaid, moved her to favor higher taxation to afford a single payer system. Schwab said there's a nearly perfect storm of opposition to that, bringing Congressional and constituent unwillingness together. "Somehow, we don't want to pay for our own health care," Eden remarked.

A man in the audience suggested there should be insurance for the big medical issues while lesser medical incidents could be covered individually. Golash said most people want a solution that covers broadly, not programmatically. Buettner says his company has what could be called a Cadillac plan ("Rolls-Royce" was another popular description), and he wondered why he should also, in effect, pay for the health care of fast food workers, necessary though he found their health coverage to be. Schwab agreed that coverage shouldn't be expanded at the expense of those already covered. But she also believed that the illegal aliens issue would have an impact on the better off. Eden, meanwhile, returned to his specialty when a tiff about the meaning of healthcare "rights" came up. If he had to call insurance for children a right, he would. The fact of uninsured kids is "a disgrace", he said. Golash observed that the capitalist model is malfunctioning. Competition is supposed to drive down prices, he said, but, he found, "not in New York".

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