America’s Failing Healthcare System

Dec. 27--Practically every day this year brought some alarming news about America's failing healthcare system, whether it's the hundreds of millions of dollars thieves are stealing from Medicare or losses pouring from the Jackson Health System.

The coming year won't bring a magic cure, but steps leading to a recovery can be taken if only our leaders can muster the political will.

Locally, the Miami-Dade County Commission this year acknowledged the futility of running a public hospital with an unwieldy 17-member board. That board hit the wall when the economy went bust and revenues dried up, to be replaced by a seven-member Financial Recovery Board designed to be more agile and decisive.

It inherited a colossal problem that had been building for decades. Jackson had lost $337 million in the previous two years, and it lost $95.1 million more in the fiscal year that ended Sept. 30, with taxpayers left holding the bag. Willing to try something new, the board named Carlos Migoya, a business-savvy former banker to lead a rescue effort. Mr. Migoya has come up with some good ideas, like seeking more community doctors and offering more private rooms to lure paying patients.

The overhaul remains a work in progress. Jackson will ask more from its workers, who have already had to accept cuts in pay and job furloughs. The board must find a more compatible relationship with the University of Miami Medical School. Ultimately, it must consider transforming Jackson into an autonomous, nonprofit entity free of political ties, but at least, for now, the patient is getting the right attention.

At the state level, Gov. Rick Scott is trying to persuade the Obama administration to give Florida a waiver from federal requirements in return for Medicaid funds. The main issue is how to control the unmanageable costs -- Medicaid now takes the lion's share of the state budget -- without shortchanging patients. The irony is that Republicans in Tallahassee condemn the federal healthcare overhaul for "rationing care" but they've devised a system that perforce rations care for Medicaid patients by putting them into managed-care systems.

Whether this is a good idea is unclear because the effectiveness of the state's Medicaid reform plan has yet to be tested. But a recent study by Georgetown University and a private fund says 800,000 people may be forced out of Medicaid if they must pay the state's proposed $10 per month premium.

Meanwhile, Gov. Scott has turned down millions in planning funds from Washington to begin implementing the Affordable Care Act, under the dubious theory that it's not legal until the Supreme CourtMr. Scott should do likewise.

The Supreme Court's failure to uphold the Affordable Care Act would be a huge setback for reform. Consider: Florida is the lead plaintiff in the case, and yet the sorry state of our state should be Exhibit A for the federal government, given that 20 percent of Florida residents don't have insurance and have to rely on public charity (the rest of us) when they have to go to a hospital.

Until the court decides, though, there's other work to be done at the federal level. At last count, 781 cases of Medicare fraud had been brought in the Southern District of Florida between 2005 and 2011, involving $2.9 billion in fraudulent claims. A total of 160 defendants were charged in the year that ended Sept. 30.

With South Florida still accounting for one of every three Medicare fraud cases in the nation, prosecutors should continue a full-court press until crooks understand that trying to game the Medicare system leads straight to jail. And the federal government should make sure service is delivered before payment is made. That alone would go a long way towards fixing one of the most vexing and wasteful problems in the realm of healthcare.

___

(c)2011 The Miami Herald

Visit The Miami Herald at www.miamiherald.com

Distributed by MCT Information Services