ILWACO - The dire state of medical treatment in the United States for the uninsured, and low-income elderly and young got an up-close local look Oct. 26 at a forum at the Ilwaco Heritage Museum.
With a panel made up of county and private agencies and U.S. Rep. Brian Baird, the Lower Columbia Health Care Project forum was sponsored by radio station KMUN, the Chinook Observer, ShoreBank Enterprise Pacific and Columbia Memorial Hospital.
Given the beautiful weather that day, the near-capacity turnout at the museum's meeting room brought home the number of people concerned about health care, or lack of health care, in the region.
Panelists were Dian Cooper, of the Family Health Center in Klipsan Beach; Pacific County Sheriff John Didion; Pacific County Commissioner Pat Hamilton; Ocean Beach School District Superintendent Tom Lockyer; Baird; Jim Robertson, CEO of Ocean Beach Hospital; Ann Rockway, clinical director of Timberland Regional Support Network; Doug Sheaffer of Senior Information and Assistance; and Kathy Spoor, director of the Pacific County Department of Health.
Before discussion began, Shore-Bank's Mike Dickerson introduced the new general manager of KMUN, Peter Newman, who will head the station beginning Dec. 1.
Identifying goals and key players was the purpose of the forum, said forum moderator Matt Winters, editor of the Chinook Observer, adding that he would address needs and priorities in the newspaper in coming months and years.
Panel members outlined key issues:
The Family Health Center at North Beach aims to eliminate health-care disparities among low-income and racial and ethnic minorities, Cooper said. "We leverage funds and make every penny scream," she said, adding that the clinic "cares for anyone who walks through the door, and we help with insurance and prescriptions." She said beginning in January, the clinic is collaborating with the Gallery Pharmacy in Long Beach on an up-to-50 percent discount on prescriptions for the clinic's patients.
"There are way too many people who can't afford basic health care or medications through no fault of their own," Cooper said. She added that even clinic employees are looking at an 18 percent increase in their insurance premiums next year.
Didion emphasized that communication is critical to "bridging the gap from making an arrest to not having to" and pre-empting high-tension situations by giving treatment and care to young people before they get into trouble. Saying he was a DARE officer for 18 years before being elected sheriff, Didion said he had more impact on young people through the program with one-on-one interaction. "Arrests aren't a fun event," he said, and it is vital to contact and treat young people before law enforcement gets into the act.
Hamilton, a county commissioner for 14 years, commended Spoor for getting grants for people without insurance, then noted the "delicate balance" in the funding for the county. "Right now, we're living on 1997 dollars," she said. "Next year, we'll be living on 1995 dollars. The costs for insurance for county employees with families is prohibitive," she said.
And, malpractice premiums for doctors continue to soar. "Malpractice premiums are $100,000 a year. We've lost a third of our doctors. We could lose another 50 percent," she said. With lawyers getting 55 percent of settlements in malpractice cases, "We need tort reform," she said.
The state needs caps on prescription drug costs, Hamilton said. "They do it in Germany. They do it in Canada. Why can't we?" Dental care for low-income families is another urgent need, she said. "We have to take this seriously."
Health care major issue in local schools
Superintendent Lockyer cited the difficulties and challenges of working with more than 1,100 students in the school district with reduced budgets and unfunded federal legislation.
"Kids are the future of the community," he said. "If we don't partner with the community, we're in for a difficult time."
Health care is a major issue in the schools, Lockyer said. "How do we prepare kids before they come to school?" Another challenge is creating after-school activities. "Grants are difficult to acquire, and they don't come to small counties," he said. "We really need after-school programs for kids so they don't become problems. If we don't have them, they'll end up with law enforcement."
Saying the news from Washington, D.C., "isn't cheery," Baird said he believes the number one problem in the country is health care.
"More than 43 million people are without insurance," which he added could rise to 70 million. "People without insurance have to make terrible decisions if they have symptoms of disease. They wait till the symptoms go away, or they go to the emergency room which costs much more. The system is inefficient."
Reimbursement for Medicare and Medicaid patients is low in the state, Baird said, and two years ago, 47 percent of the state's doctors wouldn't accept new patients in the programs. "They can't afford to lose the money."
Employee insurance premiums are rising, Baird said, and drugs need price controls but "the majority in Congress steadfastly refuses to put a cap on prescription drug prices. They fought it vigorously because big pharmaceutical companies are the biggest players in lobbying and advertising. Just look at the ads on the evening new shows," he said. "Money is going to advertising, not to research." Veterans' health-care programs are being cut, as well, he said, and there's a proposal to close portions of the Veterans Administration clinic in Vancouver.
With a projected $600 billion deficit, over the next 10 years the country's debt will double, from $7 trillion to $14 trillion, Baird said. A $400 billion prescription drug benefit program is proposed "but we don't have the money," he said. "Cost control is the best way" to get a handle on drug prices, he said, and the best way to control costs is through prevention and personal responsibility. "Fifty percent of illnesses are preventable," he said, such as drug and alcohol abuse, smoking and obesity. "It doesn't cost anything to address these issues behaviorally."
Vast amounts of paper work medical offices face with different insurers is "an inefficient use of health care dollars," Baird said. "It's a proliferation of bureaucracy. We need a national discussion on this inefficient delivery system. We should be able to cut overhead and revisit the whole operation."
Where have all the Marcus Welbys gone?
"There are no more Marcus Welbys or John Campiches," hospital CEO Robertson said. "Doctors don't come to a community and stay for life any more." Praising the "tremendous vote of confidence by local residents for the new hospital" and for the bond for upgrading Peninsula schools, he said businesses thinking of coming to the area look at education and health care access.
A number of doctors have been recruited to come to the area for five years, but they move on after they've fulfilled their commitments under a U.S. immigration program. Now local patients have to travel to Longview, Vancouver or Portland for secondary care doctors but "the new hospital will attract secondary care doctors," Robertson said. "That will be a great thing for the community. Uninsured doesn't mean uncared for. Between the Family Health Clinic and the hospital, we'll find some way to get them care and find a way to pay for it."
Liability rates for hospitals doubled last year, Robertson said, and doctors at Willapa Harbor Hospital in South Bend are no longer able to deliver babies. "The OB program has been dropped at Willapa because of the high cost of malpractice insurance," he said, adding that this is a nationwide problem.
The hospital and its clinic are not being reimbursed for Medicare at current critical access hospital rates, Robertson said. Consequently several hundred thousand dollars are owed to them.
On the positive side, though, Robertson said the college nursing and laboratory and X-ray technician programs offered locally could help with the manpower shortage in hospitals. "We need to point kids in the direction of health care careers," he said. "They'll always have a job anywhere."
Timberland Regional Support Network's Ann Rockway said the major issue facing her mental health agency is the "increasing pressure to be less flexible than in the past." She said previously she could spend money where it was needed "with less attention to the funding source. Now, with Medicaid, we're being penalized financially." But, Rockway said, the agency will continue to operate regardless of funding levels.
Timberland is moving toward focusing on recovery systems and educating its clients that they can recover from a mental illness, Rockway said. "We're teaching them to self-manage and to take more responsibility for their lives," she said, as well as working to increase collaboration between providers and families so they can be more effective.
"Our main issue is struggling with a dearth of acute care resources," Rockway said. "Doctors are reducing their access to people without insurance. When it's midnight and someone is suicidal and needs hospitalization, we have to take them to Yakima for treatment. It's very disruptive to people's lives."
With the highest percentage of people 60 and over in the state and the highest number of people older than 65 living in poverty, Pacific County faces some real challenges, Sheaffer of Senior Information and Assistance said. He said there are many grandparents in the county who are raising their grandchildren, as well. "Senior issues are already upon us," he said. "Everyone is getting old.
"We need to identify what's out there," he said, and coordinate existing services. But people don't want to look at what services are available until they need them. Coordinating in-home health care so people can stay in their homes as long as possible is a big part of the picture, as is access to health care. "When some of my clients have to travel to Longview to see a doctor," Sheaffer said, "it takes them a week to recover. It can be very scary. The information about available services for seniors needs to be publicized."
Budget cuts hit county health department
Budget cuts have hurt the county's department of health, Spoor said. "In 1995 we had $185,000 in timber money," she said. "In 2004, we'll be getting $94,000 and our budget is $1.5 million. Administrative costs and demands are increasing." Poverty-level families face challenges with access to affordable care. Spoor said her department emphasizes the importance of preventive measures such as flu shots and immunization and that access to transportation and dental care are big issues.
Another real concern for Spoor's department is depression and lack of hope among young and old residents. And a growing problem for her department is how to integrate a growing minority population into navigating the health-care system. "I hope we'll come out of this meeting with new ideas about how to work together," she said.
Having voiced the problems among state and county agencies, Winters asked the panel to name important goals and how to accomplish them locally. "A lot of it comes down to funding," he said. "Should we look at a law enforcement levy? That would mean a tax increase. What can we actually accomplish? We need to start before birth and channel people into healthier lifestyles."
He challenged the forum to start coming to a consensus and attempt to accomplish their goals. "We have a new hospital and will be having new schools," he said. "What's the next step?"
A good first step would be prevention, managing chronic disease and identifying self-management goals such as getting away from the TV and walking, Cooper said. "We need to get together and figure out how to help each other." She said the Family Health Center had applied for a grant to fund dental care. They didn't get the grant, but will be re-applying again in January.
Cooper also asked local residents to tell their stories about not being able to access medical care, of traveling to Longview to see a doctor, "Stories of real people," she said.
"We raised public awareness today," Didion said. "I firmly believe we need to step up and say 'enough's enough.' Everything is secondary to public safety. What will make changes happen is when you stand up and say 'This needs to be a priority.'"
Unfunded government mandates are a big problem for the sheriff's office, too, Didion said. "We need to start today and take steps."
"Every department in the county has been stripped to keep sheriff's deputies on the road," Hamilton said. "This is an untenable situation."
Big gap in Medicare reimbursements
The huge discrepancy in Medicare and Medicaid reimbursement rates among states is a major problem, Hamilton said. The rate is highest in Florida and varies widely from state to state.
As Baird said later in the meeting, reimbursements are "vastly overused in Florida. People there go to the doctor's office like it's a social club." He advised contacting Rep. Jennifer Dunn about the reimbursement discrepancies. "If that's not effective, write to the president and the presidential candidates urging them to do something to correct the imbalance."
Hamilton agreed with other panel members that unfunded mandates "are no fun. The consequences of those are a real issue."
"The key issue is awareness of the problems," Lockyer said. "We need to look at what's in place and rely on volunteerism. There's a tremendous wealth of knowledge out there." He said a new committee has been formed, headed by Allan Fleck, to collaborate with agencies on the Peninsula to provide services to parents and children aged from birth to 5 years old. The program would collaborate with agencies and help parents have their children ready for school. Head Start, district, day care and church groups are involved. He urged residents to contact Fleck at the school district office at 642-3739 and "let him know what you can do."
"You aren't alone in your struggle," Baird told the group. He said in the 200 town hall meetings he's attended since taking office, "health care is the top issue. This community has done things right with coming together to get the new hospital. The Economic Development Council is doing great work, too."
Addressing the "inexorable demographic changes" of an aging population "we must get ready for long-term care," Baird said. "We need to know how many will need it, how we can get it and how it can be funded. We need to address the shortage of health-care providers and sponsor kids in medical school. If they come back here to practice, it's possible we can create some Marcus Welbys. With the EDC, we can work with schools and sell the community." He said innovative programs are in place nationwide to persuade doctors to come to rural communities. Locally, an unlimited supply of salmon and crab could be offered to get them to come here and stay, he said.
Meeting the health-care needs of minorities is a big issue, Baird said. "We depend on migrant labor," he said. "They pay taxes, their children go to local schools. We need to work with them to be sure their health care needs are met and resist the urge to point fingers.
"We need to be honest about a couple of things," Baird concluded. "It's not realistic to cut taxes and increase services. We need to be cautious."
Robertson agreed that participation in their own health care and encouraging healthy lifestyles is important for Peninsula residents. And he added that the health-care staff at OBH "is the best I've worked with in my career," citing statewide recognition for the hospital's diabetes program. Technical advances at the hospital will provide better testing services for patients such as Ultrasound, MRI, CAT scans, state-of-the-art X-ray equipment and new pharmacy and computer systems, he said. "There's lots of stuff going on behind the scenes."
More forums like the one Sunday are needed, Sheaffer said. "There are many volunteers working quietly behind the scenes but we don't hear about them," he said. "We need to get the information out, and it needs to be streamlined."
"We need to commit to being creative and to think outside the box," Spoor added.
Audience chimes in with major issues
Questions from the audience brought Jane Graves to the microphone to say that five pharmaceutical companies control all drug manufacturing. "We pay 300 percent more for drugs than any civilized country in the world," she said and asked if it was common knowledge that three heads of the big companies are under indictment. "Why don't we know that?" she asked.
Congress has tried to constrain the pharmaceutical companies' monopoly, Baird said. "But they make large political contributions."
Ilwaco City Council Member Shirley Burt spoke for the Partnership for Medication Access for seniors that provides free prescriptions for low-income seniors with no insurance and asked them to call her at 642-4317 to sign up or for more information.
Elizabeth Hadley, director of the Head Start program on the Peninsula commented that the Bush Administration "is taking shots at Head Start." Participants in the program are often anemic and don't receive vision and hearing screening, she said. "Twenty-seven percent of our kids failed hearing screenings in Pacific County, 56 percent have diagnosed health-care problems and 42 percent have dental needs.
Quality health care for the Hispanic community on the Peninsula is a big concern, said Cindy Yasunaka, who heads up the school district's migrant program. "They find discrimination at local clinics," she said. "Sometimes they're made to wait two to five hours for service and end up going to Astoria. This is an ongoing issue. I want to see them made comfortable here." She said transportation and lack of translators also are issues, as well as mental health outreach. "The mental health system is hard for them to navigate," she said, "and Willapa Counseling has huge gaps."
As for forum ended, Winters commented that the group had "just scratched the surface. Where to we go now? What will we do with this advice and information? Should we have more meetings? We have a common set of goals."
He thanked Margarita Cullimore for organizing the forum.