SIKESTON -- While identifying major problems and their contributing factors is easy enough, coming up with solutions to our nation's health care problems is anything but simple.
The first in a series of Health Care Roundtables with physicians and health care facility administrators hosted by U.S. Rep. Jo Ann Emerson was held Monday evening in Sikeston.
"I'm here to listen," Emerson said in opening the discussion. "Health care has been a passion for me since I was elected."
The meetings are being offered as an opportunity for stakeholders involved in the delivery of health care services to discuss issues immediately affecting the future of health care in Missouri and across the nation.
This series of roundtables is only for health care industry officials but Emerson's staff said public meetings will be held in the future.
Emerson said the issues are complex and she does not fully understand all the problems health care providers are facing, "nor do my colleagues."
Medicare is "still in the 1965 model of health care delivery," Emerson said. "We have, obviously, a huge crisis in health care." She noted that while the cost of providing care is the same in cities or rural areas, rural areas receive a lower rate.
Also, while the cost of providing medical care remains the same or is rising for physicians, reimbursements from Medicare for them are going down.
Emerson noted that Medicare money is federal, but is controlled by the state. She asked if perhaps the whole system needed to be dismantled and rebuilt.
One local physician said the poor reimbursement rate for physicians creates difficulties both in the retention and recruitment of physicians. "We are close to a walkout," he predicted.
Emerson also discussed the cost of prescription drugs. "The cost of drugs is just astronomical," Emerson said. She suggested the answer to this problem may be creating more competition with generic drugs.
The hottest topic of the evening, however, looked at one of the major causes of two health care issues - skyrocketing health insurance and malpractice insurance premiums - the "lottery" windfall awards in malpractice lawsuits.
One doctor said that while he understands the idea of "sending a message" with punitive damages, he believes the punitive damages should go to the government instead of to the victim and the lawyers. "Nobody should make a fortune of misfortune," he said, "but they should be treated promptly."
Emerson said the House passed a tort reform bill last year based on legislation in California, but it was defeated in the Senate.
With the Republicans now controlling the Senate, there is still no guarantee that such legislation will be passed, but "the chances of enacting something in the Senate is reasonably improved."
Emerson posed the question, however, of why two of the states with tort limits, Florida and Michigan, still have the highest malpractice premiums.
Among the possible reasons offered for why tort reform hasn't appeared to work were that there are fewer malpractice providers and more lawyers per capita in those states as well as plenty of loopholes in the tort laws themselves.
Dr. Anthony Poole of Sikeston said Missouri had tort reform in 1986. "It helped, but not enough," he recalled.
With tort reform, "nothing really changes," said one Kennett surgeon. "There has got to be some disincentive to sue."
The suggestion of a "federal malpractice pool" much like workers' compensation from which claims would be paid and into which punitive damages could go continued to resurface during the discussion.
The idea of having a committee decide malpractice lawsuit awards instead of juries was also suggested several times.
All the physicians seemed to agree that it has become a climate in which they are "practicing defensive medicine."
Being overly cautious due to the threat of a lawsuit, physicians routinely order all sorts of additional tests they otherwise would not have asked for. "That's one of the reasons health costs are being driven up," one doctor concluded.
One suggestion is that there should be a penalty for filing frivolous lawsuits.
At the mention of a national health care system, one physician countered that physicians would be all for it once lawyers agreed to cap their fees for services.
Emerson will continue her Roundtables today from 6:30-8:30 p.m. in Poplar Bluff followed by sessions in Farmington Wednesday, Rolla on Thursday and Cape Girardeau on Friday.