Concerns at Forum Reflect Health Care Reform Challenges

Everyone at the 5th Annual Michigan Business & Legislative Forum on Oct. 9, 2009 agreed that the U.S. has the most expensive health care system in the world, but doesn’t always get the best results. The panel of health care experts, two U.S. Congressmen and the majority of the 400 attendees also agreed that the rising costs of health care are a financial drain on families and an obstacle to economic growth.

The Future of Healthcare Panel at the Michigan Business & Legislative Forum.

Whether the health care system should be fixed was never a topic for debate at the Fairlane Club in Dearborn. The understanding that this country’s health care system was broken and needed fixing appeared unanimous.

Interestingly, everyone seemed to also agree that pre-existing health conditions should not be a cause for anyone to be denied health insurance coverage. Moreover, there was general agreement that no one should be dismissed from insurance coverage when they do become ill.

The debate centered on how we were going to fix our health care system in this country. Nearly every presenter and participant who questioned the presenters was opposed, to some degree or other, to the proposed Democratic policy for health care reform. Many disapproved of the total package while a few others selected a particular topic within the proposal for their objections. The approaches and solutions cited at the forum for health care varied greatly depending upon financial interests, political leanings, and religious values.

Murray Feldman of FOX 2 News moderates the discussion.

Hosted by the Michigan Business and Professional Association for its members, the purpose of the forum was to find out how health care reform will be relevant to Michigan business. Business and health care leaders were invited to present their perspectives about how the current reform package affected them as a business owner, what proposed strategies are viable for Michigan, and how will health care reform strengthen the state’s economy. Audience participants were invited to question the speakers.

Anchor and Money Editor for FOX 2 WJBK, Murray Feldman, hosted the first discussion which consisted of a panel of health care specialists.

“The demand for health care is insatiable,” began Dr. Mark Kelly, executive vice president of Henry Ford Health System and CEO of Henry Ford Medical Group. He commented that the debate on health care reforms centers on what special interest groups are willing to accommodate and give up in order to obtain universal coverage, which most are demanding.

Panelist Dr. Mark Kelly of Henry Ford Health System.

In response to a question about hospitals adjusting to the possible changes of health care reform, Kelly stated the need for an integrated health structure so that organized systems, such as Henry Ford, are paid for complete episodes of care, eliminating the chance to run up hospital bills for piecemeal testing and medical events. He used the term “bundle payments,” to describe the billing process which is similar to the one used at Mayo Clinic. Their accounting practices appear to enable doctors and hospitals to work together and reduce costs. Kelly’s goal is for doctors to do more work as doctors rather than merely prescribe more testing.

The panel acknowledged that our current health care system imposes a heavy burden on small businesses and their employees such as paying up to 18 percent more per worker than large firms for the same health insurance policy. These higher costs are often passed on to employees through lower wages, and may deplete the profits that a small business could be using for research and development. As a result, small businesses often provide less health insurance for their workers than large business.

Panelist Mark Cook of Blue Cross Blue Shield of Michigan.

Mark Cook, vice president of Governmental Affairs, Blue Cross Blue Shield of Michigan, agrees that the business of health care needs to be revamped. He gave as an example the cost that takes place when most uninsured people wait until they become sick before they see a physician. These sick people then purchase health insurance at Blue Cross, which is required to take everyone as the insurer of last resort. Everything costs more, he explains, because emergency services for treatment are more costly than early detection and treatment which cost less. One of Cook’s objections to formulating a public option for the uninsured is not knowing who is going to pay for that cost.

Without bipartisan support, the approaches to health care reform are unacceptable to Mike Embry, senior account director, Comerica Insurance Services. Embry showed much concern about consumer protection issues such as dropped insurance coverage when a policyholder becomes ill or has a pre-existing health condition. When asked what was his top priority for the health care reform bills Embry replied eliminating fraud and waste. He wanted the bill to include wellness programs, and provisions for electronic medical records. At the same time he looked for the bills to have an ability to build an enforceable individual mandate.

Panelist Mike Embry of Comerica Insurance Services.

Kathrin Kudner, attorney at Dykema, representing much of the health care industry, spoke about the possible legal ramifications of the bill and the fact that raising costs for health care without also raising the quality of care was unacceptable. On the other hand, she commented that some of the tax credits listed in the bills did benefit small businesses and individuals and provided consumer protections to small companies willing to offer health insurance to their employees.

In addition to an individual mandate, Kudner said individuals should have a medical home or a primary care physician. According to the current status of the bill, she pointed out, primary care physicians would receive an increase in reimbursement. She felt strongly that provider prices and quality need to be clearly indicated so that consumers may shop for their doctors.

Panelist Kathrin Kudner of Dykema.

Cook said that the Michigan Blues already does a lot of what is being advocated at the federal level because as a nonprofit organization, profits are not returned to the owner, but put back into the company. Moreover, Blue Cross Blue Shield of Michigan (BCBSM) already has a pay per performance in place within its Keystone project.

“As our pool becomes more sick and older we see the need for a stronger individual mandate so that the younger and healthier population are also included in the pool,” says Cook, who is looking for the bills to require individuals to purchase health insurance so that everyone is insured regardless of a pre-existing condition. He feels that amendments to the bills are watering down the penalties to exempt some people from the mandate.

Two Republican Congressmen, Peter Hoekstra, R-2nd District and Mike Rogers, R-8th District, also presented their perspectives on the health care reform bills and answered questions from the audience. For instance, they were both very negative about taxes possibly being collected starting in 2010 for the new health care reform act while implementation of the bill wouldn’t begin until 2013, four years from now.

Hoekstra agreed that something needs to be done, but it was a question of “freedom” when it came to approving the proposed health care reform bills.

According to Hoekstra, health care is 18 percent of the U.S. economy and he’s unwilling to give 18 percent of the revenue stream to the federal government. “If I can, I want to control how my revenue stream is spent.”

U.S. Congressman Peter Hoekstra states his opening comments on Healthcare Reform.

Hoekstra is convinced the Democratic health care proposal will hurt small businesses because the bill imposes mandates, penalties and additional taxes on small businesses to help pay for government-run health care. For example, if employers don’t provide health coverage, they will be taxed. If an employer does offer health insurance, but the employee decides to enroll into a government approved policy, the employer still is taxed for that individual.

He feels that if we “tinker with some of the things that are already broken” and move ahead for continued improvement, we’ll be better off and have a better system at a lower cost. Hoekstra has no intent on giving up the fight because, as he explained, his experience shows that the government seldom returns anything it receives, even when that something may not be working.

Hoekstra also showed much concern for the power of the Health Commissioner who would be granted the authority to decide which insurance plans are available, which treatments are available and at what costs, and which families qualify for government subsidies for health care. The Michigan gubernatorial candidate says he does not support a government run or ‘public option’ included in the health care reform legislation.

U.S. Congressman Mike Rogers states his opening comments on Healthcare Reform.

Mike Rogers’ approach to the current bill matched closely with Hoekstra. Both believed the enactment of the health reform bills would cost too much money, that small business would be overburdened, and that the government would be taking over the health care industry

Rogers does not believe that government-run health care is the solution to this country’s problem. He emphasized the need to maintain the entrepreneurial foundation of the country and the many small businesses which count on the free market system. He said that the results from the recent town meetings across the country on health care reform indicate that the country was interested in a grass roots approach, but opposed to giving it away to the government.

According to Rogers, the goal of health care reform is to find solutions for the 15 percent who are uninsured rather than tearing down a system that serves the majority of Americans.

Congressman John D. Dingell (D-15 District), who introduced H.R. 3200, America’s Affordable Health Choices Act, was unable to attend the event, but sent a lengthy letter. The excerpt below was read to the audience:

“Our nation has a long history of protecting our elders, our newborns, and our sick. We created Social Security during a period of economic calamity. We passed Medicare legislation during a period of civil unrest and divisive war. Some of our greatest acts of compassion have come in moments when they seemed most difficult. This American Solution will help those needing care get access to the finest medical care in the world. Not only do we have a chance to do the right thing for our people, but also for our economy. The high cost of health care is not only part of today’s economic woes, but it stands to cause an even greater problem in the years to come if we do not act. We are at a crossroads, and we have the opportunity to prevent the next great economic catastrophe, but we must learn from the current economic crisis we’ve inherited. We must work together to reduce health care costs.”

Concluding the Forum were remarks by Marianne Markowitz, newly appointed U.S, Small Business Administration’s regional administrator for Region V. Based in Chicago, Markowitz works with small business associations, elected and appointed officials, and small business communities in Detroit and Chicago, as well as in Cleveland, Indianapolis and Milwaukee.

Keynote Speaker, Marianne Markowitz of the Small Business Administration.

She spoke about a mentor program recently put in place with funding from the stimulus package. It was her hope that more large and small business would develop products or programs together and implement ways they could share expenses to drive down costs while growing assets. It is her belief that when a large business serves as mentor and provides resources for business planning, both businesses are winners.

Markowitz ended her remarks advising small business owners and key employees to implement a program to prepare for the 2009 H1N1 Influenza. Formulated by the Department of Homeland Security, the purpose of the Preparedness Guide for Small Businesses is to ensure the county’s economy continues to function even if faced with absenteeism, restricted services and supply chain disruptions.

The guide is intended to help business owners plan and write a preparedness plan and encourage employees to prepare their own homes and families. This may include caring for sick family members and storing a two-week supply of food and medical supplies. More information is available at

The Michigan Business & Legislative Forum was sponsored by DTE Energy, Davenport University, Dykema and FOX 2 WJBK.