County clinic could harm local health care network

By Dr. Michael J. Pramenko

Mesa County is trying to save money in health care. The county recently decided to set up its own primary care clinic in an effort to control ever increasing health insurance costs incurred by Mesa County taxpayers. The county commissioners should be applauded for those goals. We should thank them for addressing the problem.

Our gratitude should stop there, however. They have not seen the forest through the trees.

Trying to address health care costs in a piecemeal fashion without a more community-oriented approach is loaded with pitfalls. Squeezing the system in one place causes a bulge in another. In this case, by setting up its own government-run health clinic, Mesa County is actually weakening the other elements of our community health system that have garnered so much praise over the last year.

Here in Mesa County, we have shown greater efficiency at providing quality lower-cost care to the citizens of this region, when compared to other areas of the country. Unfortunately, the current health system is not set up for this community to share in those savings. Indeed, the savings that have occurred in Mesa County are, in effect, returned to the big inefficient pot of health care dollars in the entire United States.

But it’s worth noting that portions of the recently passed health care legislation could allow more shared savings at the community level.

So, instead of working with a medical community that has been highlighted as a beacon community for efficiency, our county government has just decided to work outside that system. Not only that, but the commissioners have decided to avoid local privately run companies in favor of what is, in essence, a government-run clinic.

Our commissioners are looking for savings that exist right under their noses. We just have had no viable state or federal mechanism to accomplish the task of keeping the savings at the local level. That may change in the near future.

In addition, by steering insured patients away from the existing pool of community doctors, the county is defunding the mechanism that allows this community to provide its nationally known access for Medicaid patients.

For 30 years, the doctors of this community have agreed to be paid less for their insured Rocky Mountain Health Plan patients so that those funds could be diverted to physicians who are seeing Medicaid patients. Without this altruistic behavior, Medicaid patients would have poor access to the physicians of this community. Pulling insured patients out of this system defunds this successful program.

Health reform is a difficult problem. There are no simple answers. Indeed, there are many intertwined aspects that must be addressed at once to avoid unforeseen consequences.

So, it is shocking that two out of three county commissioners chose a government-based “solution” over working more closely with private entities to help address this problem. After all, our county government has a community of health providers who are more involved and more in tune with these issues than the vast majority of communities around the country. It is ironic that commissioners, who are vehemently opposed to government involvement in health care at the national level, seem to think government is the solution in their own backyard.

Let’s thank Steve Aquafresca for understanding the nuances of this issue by voting against the proposal. Maybe there is still time to fix it.

Michael J. Pramenko is a Family Physician at Primary Care Partners. He is currently President-Elect of the Colorado Medical Society and serves on the Club 20 Healthcare Committee.


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