Health Issues

August 16, 2005

 

Analysis

By:  Gopi’s Staff

 

Although considered quite “late”, Sen. Pedro Rosselló González (PNP-Arecibo) let all know his opinion on the Executive’s request to Medicare to dispense the Commonwealth in compelling  all Medicare & Medicaid participants under the Reforma de Salud, to join “preferred care” providers. This modality on health insurance services management had been criticized by Puerto Rico’s IPA’s groups & hospital organizations, although it did not derailed efforts by many IPA’s and newly formed groups, to promptly establish business relations with this type of already or recently established managed care entities. It is argued that it challenges “the freedom of choice” which spirited “la Reforma de Salud”.  The Senator and former Governor, who is also New Progressive Party’s President, yesterday headed the list of sponsors[1] of Senate Resolution 1153, which requests the Senate to repudiate the Executive’s intentions, and encourages CMS (Medicare) to deny P.R.’s request. See:  Gopi’s Legislative Monitor, August 16^th, 2005 Special Bulletin. 

 As of today there has been no clearly resolved legal issue as to Government’s scope of administrative sovereignty as to impose its plan without having to amend P.R.’s Reforma enabling act.  It is known that many legal experts in the Commonwealth have undergone research to that extent, including major lobbying entities like AARP.  Yet there has been no affirmative action of any legal and extraordinary nature as to prevent or derail this decision.  The head of the public health system financing entity ASES, Ms. Nancy Vega, was quoted by newspapers as late as August 15^th, as not yet having received directives to that effect.

 This initiative contrasts to Rosselló’s interruption of his early efforts to pursue through a legislative joint committee, (and after rallying different private entrepreneurs, physicians, international health organizations, etc.) a study on Puerto Rico’s health system.  This effort came after Gov. Acevedo Vilá had already recruited close and former Rosselló associate and “author” of the NPP’s health platform and reputable physician Dr. Jorge Sánchez, to assist in the design of his Administration’s effort with regards to the Puerto Rico Public Health System. Rosselló’s abandonment of this effort was prompted by the continuous leadership struggle going on in the Senate.  Once Senate President McClintock removed from committee chairs Rosselló’s allies in his quest for the Presidency of the Senate and McClintock’s removal, he decided - in solidarity with his partisans - to resign his appointment to the chair of the Joint Committee that had been established by Legislative Joint Resolution. See:  Gopi’s Legislative Monitor, March 23^rd., 2005 Special Bulletin.  Therefore, it should not to be considered odd if this resolution proposing Senatorial repudiation to Gov. Acevedo Vila’s proposed action on Medicare / Medicaid Reforma participants, is the  prelude to a “re taking” by Sen. Rosselló of the health system issue, just right where he left it in 2000.

Contemporary to all of the aforementioned, health system & services interested entities should not loose track of Rep.  Gabriel Rodríguez Aguilú’s (NPP-Rep. Dist.13) continuing investigation on the public health system, which included press live coverage of the House Committee on Health’s ( which he chairs) visits to Centro Médico’s Emergency Room, and other public medical facilities.  These legislative activities have been supplemented –newsworthy- by Omaya Sosa Pascual’s series of articles on Mental Health care of chronically ill patients.  If in addition, the issue of budgetary restraints continues to draw debate, government health costs, particularly mental health and pharmaceutical expenditures, should undoubtedly undergo close scrutiny from NPP dominated legislative majority in both Houses. 

 Once and if the sums of all proposed government health services expenditures are ever considered and analyzed by concerned parties, it is expected that the Administration will need of special abilities to demonstrate its capability to provide equal and better services than those presently provided by private health care organizations, under similar and competitive cost and expenditures   restraints as demanded by Government from private providers under present contractual conditions.  It is expected that Government’s payroll allocations by itself, will reveal great management incompetence, as well as, excessive and unnecessary costs.  This could derail ASSMCA’s Director’s demands and aspirations for absolute and total control (administrative and operational) of all public mental health services and funds in Puerto Rico. 

According to economic models and/or projections prepared by health industry experts, under present expenditure levels, ASSMCA’s proposal would require an approximately 135% increase in Government’s health services expenditures (and additional $88 million) from present levels.  This represents an additional allocation of an estimated amount in hundreds of millions of dollars ($145 million) to ASSMCA’s operational budget.  Unnecessarily delayed hospital stays and pharmaceutical expenditures (basic elements of effective cost control industry strategies), in addition to payroll, are some of questionable excessive expenditures which characterize government provided services and could be the subject of predictable debate and controversy.2 

 Interestingly enough, most providers which will necessarily become ASSMCA’s providers if its proposal is adopted,  are presently under contract by the private entities; as is ASSMCA itself.  How does this proposal will make better doctors or professionals, of present caregivers?  Is it been suggested that health professionals in Puerto Rico are not giving their best to Reforma patients?  Notwithstanding the fact that present services are rendered by private entrepreneurs under more reasonable financial terms and administrative flexibilities than Governments’; and the present needs of other public health services entities like Centro Médico: will Gov. Acevedo Vilá insist in okaying AMSSCA’s proposal?  These are some of the many issues or questions either to be resolved or answered during the next weeks.    

 If as announced, Gov. Acevedo Vilá’s advisory committee issues its findings and recommendations within the next 30 days, and Sen. Rosselló has decided to make a comeback on his most valuable political weapon – la tarjeta de salud – it will be safe to forecast for this forthcoming Fall, a very interesting and heated debate on public health care in Puerto Rico.  Evidently, the Governor’s Committee, notwithstanding Dr. Sanchez’ distinguished record and recognized dedication and personal sacrifice to the completion of the entrusted task, will not be free of “conflict of interest” charges, no matter its final recommendations.  It is observed that the Committee’s tasks have included financial and market considerations which personally compromise members of the Committee or associates, and particularly members of the specialized working or subject sub-committees, recruited to assist principals.  It is conceivable to affirm that a society like Puerto Rico’s so used to the “give and take” to political charges and countercharges of corruption will not be immune from such accusations when committee members entrusted with recommending implementation of public policies are necessarily and directly affected by the Committee’s final recommendations.

 It is of outmost importance to notice that the Government’s proposed actions could be expeditiously implemented.  If so, they would entail unemployment for hundreds of employees presently employed by private providers.  Government’s plans (including unconfirmed reports of implementation of ASSMCA’s aspirations) could take place as soon as January 2006. For many it could be a very cold tropical Christmas Season.