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OurBlook interview with Jim Lacy, CFO and counsel of ZirMed Inc., Louisville, Ky.
 From your vantage point of the health care industry in revenue management, is there really such a big problem or number of big problems with health care in America that a revolutionary overhaul is needed? If so, what are these problems that you see first-hand?
JL: Like any complex system, there are a multitude of interrelated items that culminate in the health care delivery dilemma. Two of the overshadowing items that contribute to the loud call for overhaul are (1) the lack of clarity regarding the quality of care in the U.S. and (2) the absurd disconnect between the goals of a third-party payer system and the individual's demand for care. I am concerned that these two macro factors are not being addressed, but rather perpetuated.
With subjective reports from the WHO that call into question the U.S.’ leadership position in health care delivery and actually place it far from the top, there appears to be an acceptance that the U.S. system is somehow broken. Rarely are the WHO’s measurement factors scrutinized and reviewed. I approach this element simplistically: If I found that I had a serious, life-threatening illness and could travel anywhere in the world to have treatment, where would I go? Over 99 percent of the time, I would stay in the U.S. And, there are not areas in the U.S. that I would not travel for fear of a health related risk.
Second, I believe we are just beginning to see the benefits of a consumer driven health care system and are experiencing the benefits of giving the consumer power over health care dollars, and now we are talking about a government sponsored (subsidized risk) pool for health insurance. I believe that the failure of our government subsidized loan program illustrates that this model neither encourages competition in the markets nor is a safe financial move for the U.S.
(Editor's note: the World Health Organization ranks the United States as having the 37th best health care system in the world, behind Dominica (35) and Costa Rica (36) but ahead of Slovenia (38).)
Do you think there's much fraud or misuse of the system in health care from users, practitioners and third parties? If so, what's the most frequent thing you see?
JL: There is fraud, and while it can be hyped into a systemic issue, the truth is that there are very low impact techniques to detect, prevent and circumvent fraud. The larger issue in this category is the cognitive overload that health care providers are facing with rapidly evolving therapeutics, medicines and treatments. The gap between the art of medicine and the science are beginning to create issues in the treatment patterns and approaches that are resulting in varying courses of treatment and vastly different cost profiles for similar episodic illnesses.
Proponents of the so-called Kennedy plan the Democrats are trying to push through insist strong federal government controls are necessary to broaden coverage and stop the skyrocketing costs of health generated in the current market-based system. Opponents say it would be a radical expansion of government power, and that a government program would balloon out of control. Your thoughts? Are there any provisions in the bill you especially like or dislike?
JL: I have concerns, strong concerns, that the federal controls will limit access to care, curtail advancements in health care treatments and thwart the U.S.’ efforts to create a more efficient system. The governmental control and regulation model will only exacerbate the treatment vs. prevention situation and continue to promote the disconnect between the person receiving care and the entity paying for it.
Do you feel a public plan is necessary if reforms include mandated health coverage?
JL: No. I am concerned that industry participants are too short-sighted to see that failure to work in concert for some perceived changes could result in government oversight.
While Medicaid is frequently derided as an out-of-control failure, Medicare doesn't seem to get much criticism. Do you think it is a success, and would any of its features be good for carrying over into any broader medical plan reforms? What if anything should be done with Medicaid?
JL: Medicaid is a government control and highly regulated program aimed at populations that would otherwise be uninsured. I believe that Medicaid is more likely the result of a larger program for governmental intervention. I respond to the success judgment with a question, “How shall I view the effectiveness of Medicare?” There are certain elements that are quite successful and others that are clearly not adequate. But, this is a complex demographic in the U.S. and one that has paid in for Medicare coverage for nearly 30 years. If the financial viability of the Medicare trust fund is the gauge, is the failure one of medical or fiscal proportions?
Rationing has been a problem with Canada's system. Do you think there’s any reform that could increase the number of Americans covered without rationing?
JL: I do not think there is any reform that would be government mandated without rationing. However, I am confident that better education (bridging into our school system), prevention programs and clinical investments could result in fewer instances of “crashing” into medical emergency; thus, mitigating the impact of modifying delivery systems.
The major players so far in the health care reform debate represent powerful interests such as drug companies, doctors and those who wish a big expansion of federal power, but small business plays a vital economic role in any discussion of costs to employers. What role do you see small business owners playing in the debate?
JL: Small business’ voice is focused elsewhere. The fact is that there are more pressing economic matters than the cost of health insurance. It ranks, but others are more important.
How do you see the debate playing out in Congress this year? Do you think we will see sweeping reform at the end of the day or minor tweaks? Do you see any Republicans crossing the aisle to support a public plan? Do you see any Democrats crossing the aisle to oppose it?
JL: I am no oracle and my ability to forecast political action is worse than that of a weather person. However, the likelihood of real change will hinge on the successes or failure of policy from other sectors, such as banking, trade and decision related to foreign policy. No politician will be against health care reform, but being “for” anything is dangerous ... unlikely to happen.
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