S.D. Forum Debates Health Issues

Rising insurance costs and increased government spending could trigger changes in the nation’s health care system, according to some participants in a health care discussion Tuesday.

Republican Sen. John Thune, who sponsored the round table talk, said the federal government can’t continue to handle the 8 to 9 percent annual rise in Medicare and Medicaid costs.

“We are on the cusp of a fundamental decision on what could be a paradigm shift. Do we have market-based health care or go to a government system?” he told about 15 doctors, nurses, pharmacists, physical therapists and health care administrators.

Dave Hewitt, chief executive officer of the South Dakota Association of Health Care Organizations, predicted that “loss of employer health insurance coverage is the tipping point that will send us to a new model and change our system dramatically.”

Medicare reimburses health care providers at about 70 percent of true cost, Hewitt said. The shortfall is typically made up by charging higher prices for health care services to people with medical insurance. That is driving up the cost of such insurance to the point employers may no longer be able to offer it, he said.

Virtually everyone in the discussion told Thune that federal reimbursement for health care is inadequate. In addition to reflecting true cost, it should be broadened to pay for preventive treatments that can help avert serious injuries and illnesses that are much more costly to treat, according to a number of health care providers and administrators.

Julie Meintsma, president of the South Dakota Pharmacists Association, told Thune that the Medicare Part D drug program is working a financial hardship on small pharmacists.

Federal Part D reimbursements go through insurance companies that offer drug plans to seniors, and those insurance companies are trying to limit what they pay pharmacists at the same time drug companies are raising their prices.

It has threatened the survival of small retail pharmacists, and “we are the glue that holds the health care system together when it comes to medication use,” Meintsma said