Rick Scott was recently asked to submit Congressional testimony about how his experience informs his views of health care reform. The complete testimony appears below.
Testimony of Richard L. Scott
Committee on Energy and Commerce
Subcommittee on Health
U.S. House of Representatives
March 24, 2009
Committee on Energy and Commerce
Subcommittee on Health
U.S. House of Representatives
March 24, 2009
Thank you for the opportunity to submit this testimony.
Expanding access to health care can be accomplished by lowering costs of health care coverage and health-related services to make them more broadly affordable, or by having government either directly subsidize the uninsured or provide universal care to all.
It is no secret that I am a strong advocate of expanding access through lower costs and NOT universal care.
Why am I so convinced that this approach is the most viable?
Because I know firsthand that health care costs can be lowered, and by lowering them we open up quality health care services to those who couldn't afford them before.
As head of Columbia/HCA, we led the hospital industry in lowering costs, improving quality, increasing patient satisfaction and making care more affordable. We focused on our patients, promoted competition and measured outcomes.
As a result:
• 36% of our facilities achieved Accreditation With Commendation as compared to 8.5% of non-Columbia facilities
• Even though we operated less than 7% of the hospitals in America, we operated almost 30% of the hospitals in the Mercer/HCIA Top 100 hospitals
• 94% of our patients were "satisfied to very satisfied" with the care they received in our hospitals as compared to 88% of a national sample
• Our receipts per discharge were less than other hospitals
• Health insurance premiums were growing at over 16% per annum. By the time I left the organization in 1997, health insurance premiums were increasing at less than one percent per annum
We got results by focusing on our patients and competition. The more we measured outcomes and fostered competition, the more satisfied our patients were and the lower costs became.
The system I see today is bloated and desperately in need of that same focus.
Let's start with competition. We need to remove unnecessary state regulations that block competition of health insurers across state lines. Health insurers should be able to compete across the country and consumers should be given the widest array of choices to select from.
But fostering competition shouldn't stop there. We need to make doctors and health care providers compete as well based on costs and outcomes. That is why we should require doctors and health care providers to post their prices and outcomes so that their patients can shop and compare.
Imagine the savings that can be realized by allowing consumers to shop for health care insurance and services just like they value shop for other services. It puts the power and, frankly, the responsibility where it belongs - in the hands of the individual.
I don't say this from a theoretical standpoint, but from a practical one.
In 2001, I co-founded a company called Solantic. Solantic was founded on the belief that through healthy competition, reasonable pricing, and by putting patients in charge, we could build a successful business providing health care services that would meet patients needs while filling the gap between primary care and emergency room care. Our mission was simple: easy access to affordable healthcare.
It worked like gangbusters.
Today, Solantic operates 24 urgent care facilities throughout Florida.....and is experiencing substantial growth at a time when many companies are faltering. Our facilities serve both the insured and uninsured, and can be found in urban and rural communities alike.
When anyone walks into a Solantic facility, the first thing they often notice is a "price board" much like you would find in any Starbucks. On this board is the price for virtually every service offered at our facilities. There are no surprises -- it's true transparency in health care pricing. There is a board-certified physician on site at every one of our clinics.
And, most notable, is that the services we provide typically cost MUCH LESS than they do at the local hospital's emergency room. During 2006, for example, there were 192,312 emergency department visits in Jacksonville, FL by patients who could have been treated at Solantic. The average cost of those visits for private insured patients was $694. Comparable visits to Solantic cost an average of $111.
As for the quality of the care our patients receive? It is top notch. In fact, we offer our patients a three- day guarantee. If you've been treated in one of our centers and are not feeling better in 3 days, you can come back in and see the Doctor again at NO additional cost.
Solantic is a real-world illustration of how competition can lower costs, increase quality and expand access.
Conversely, while moving towards a single payer or universal health care system could guarantee access to all, it would do so at a terrible cost. It would strip patients of the power to make their own medical decisions, put government bureaucrats in charge of rationing care and force patients onto long waiting lists for the care they can receive.
My 30 years of experience in the health care arena leaves me no doubt that Americans desperately believe fixes must be made to our health care system. They want more accessibility for themselves and their fellow Americans AND they want lowers costs.
But based on what I've seen both here and abroad, there is no way that Americans will accept a system that rations care, takes away their rights and forces them to wait for care...especially when promoting competition and keeping patients first can lower costs and expand access to care.
Dear Rick,
I agree that we need more choice, competition, accountability and personal responsibility in order to improve quality and cut costs in our current healthcare system. A government run system would get in the way of that. Furthermore, by limiting our choices and competition, a government run system will exclude preventative and alternative remedies, and this will result in many unnecessary and costly prescription drugs, medical treatments and medical tests.
Especially with regard to psychiatric drugs and "therapies", which are quite often dangerous, habit forming and can have permanent negative side effects on patients (and therefore our society), there are often alternative remedies that work as well or better than the psych industry's proscribed treatments.
In short, a government run healthcare system will end up making taxpayers pay for MORE unnecessary and/or damaging medical or psychological treatments and testing that may in the long run be damaging to our people and our country. In addition, I am concerned that government run healthcare could eventually lead to mandating such things as vaccinations, drugs for kids labeled with "ADD" or "ADHD", psych drugs and/or treatment of criminals, etc.
Sincerely concerned citizen,
Suzanne Reaver
Dear Rick,
I too was with Columbia/HCA, as District Manager for Columbia Specialty Services, Orlando, FL market, and witnessed exactly what you what you are talking about. I'm excited to know you're still fighting for competitive quality healthcare. If I can be of any service please feel free to call on me.
Steven M. Bouffard, RRT
Dear Rick,
I'm afraid your goals are solely to promote the status quo. Who doesn't have the right to choice right now if they can afford it? Come on.... The real problem with our healthcare isn't choice. This is the same BS the Repubs have been pushing for decades. "It's your money and you should be able to choose where you put it" right.... Isn't this the same argument the Repubs used to push for privatizing social security? Remember that? Wow, I'm glad the Dems put an end to that.
Here's my story... my son is 8 years old. Has been insured since before he was born. My Insurance company (Assurant Health) just decided that since he has Aspergers syndrome (on the autistic spectrum) and needs medication and a few more surgeries to get healthy (he also had hypo-spadious upon birth) that they were going to relinquish him to the rhelm of the uninsurable. He's been covered since birth, has had coverage for 8 years and now they've been allowed in Indiana to cancel our existing policy and offer us another that no longer covers mental and behavioral healthcare coverage. It's legal and they're getting away with it.
How does your plan solve this from happening. Where's your call for a rule against pre-existing conditions? Where's your call for universal pricing for all families? Where's your call for standardized pricing that's actually usual can customary.
Please stop hiding behind the four legs of a stool argument that has no bearing on this topic.
There are people playing by the rules and allowing us to shop amongst multiple plans to get around bogus policies that don't cover real costs is not a choice. It's a false argument.
Chris Smith
Indianapolis Indiana
How much do you receive from insurance companies? They are the only beneficiaries of the current system. I have very little choice in what doctor I see. Unless I want to go to the "out of network" doctors and pay a huge penalty, I am limited to those doctors that my insurance company (whom I also do not get to choose) tells me I can. How is this "choice"?
The single-payer programs that have been proposed (where the doctors are still self-employed, by the way) would allow me to go to any doctor and receive the same coverage. Sounds like a lot more choice to me.
Stop shilling for the insurance companies and start being honest about what would be best for the 95% of the country that are not wealthy. Then I'll support your cause.
Dear Rick,
I absolutely agree with everything you say. I am a physician trained in a Government funded single payer system (Ireland) and now I work in the US. Government health care reduces patients to the levels of supplicants coming to the health system looking for help. They have no choice and no power. They get in line and take what is available. They have no redress if things go wrong. I saw this happen over and over again.
The problem is different in the US. People spend too much on health care because they never have to pay for any of it. I work in an ICU and for many patients, the hospital ends up footing the bill for expensive care that is often futile.
The answer is to empower patients by helping them buy health insurance and also make them responsible for their care and some of the costs. That should make costs come down and reward the better providers. People could choose their insurance company which would make them more responsive to people's needs.
The Government way of reducing costs is to ration care....I saw that happen too. Despite ten years of economic boom (and now bust!) and huge investment Ireland's health care system is still dire. Don't import it to America!
A better model would be Holland where people are helped to buy insurance and costs and outcomes are much better than here.
I can tell you one thing about current 'choices'. Too many Americans like me do not have the luxury of choices. I played by the rules, I'm educated and hard working. I have money. I live a healthy lifestyle. ALL THE THINGS CONSERVATIVES ACCUSE PEOPLE LIKE ME OF NOT BEING AND WE STILL CAN NOT GET INSURANCE.
I'm sick of being told I don't deserve insurance simply because an insurance company fears they may not make as much of a profit off of me because of asthma.
This is about profit. People be damned as far as insurance corperations are concerned. Well insurance companies and their payed Judas' be damned and anyone else who thinks they deserve insurance but the person next to them does not.
Interesting the word choice is used when people with pre existing conditions have absolutely no choice of any kind. It doesn't matter if they can afford insurance, they can't get it.
The word choice also does not apply to people who can not afford insurance.
People without insurance for whatever the reason can not even get in to see a doctor. So what are their choice's? Live sick and die young?? Doesn't seem like much of a choice to me and I know first hand. I receive excellent healthcare. My wife has a prexisting condition and suffers needlessly. She has no choice.
Mr. O'Reilly I think you are misinformed, terribly misinformed if you believe Americans do not pay their medical bills. I am one of numerous Americans who have sold off everything they ever worked for to pay bills in excess of $300,000. Do many of us go bankrupt because we can not pay the full amount? YES, but your saying we do not pay our bills is more than offensive to the millions of us who have lost everything trying to cover the cost of our care because we were discriminated against for being ill by insurance companies. Perhaps you should walk a mile in our American shoes before speaking for or about us.
As a health care worker almost my entire life, I'm 56 years old, and as a registered nurse the past ten, I've experienced almost every aspect of our "health care system." It's not about health at all, but profit. We aren't even asking the right questions. There are massive cost savings in humane birthing practices, for instance, including homebirth and the use of doulas, and in end-0f-life care/hospice where we literally waste 40-60% of all health care dollars on the last six months of life, and usually for nothing but increased pain and suffering, (read Dying Well by Dr. Blaylock, no it's not about euthanasia). Our present system is a joke. We don't get to keep the practitioner we like, we don't get any real choices in coverage, it's cripplingly expensive, and except for emergency medicine, substandard.
On the front page The New York Times, the article “Health Critic Brings a Past and a Wallet” shines a light on the foolish argument Richard Scott and the rest of the national health insurance naysayers spout. Scott says, “Imagine waking up one day and all your medical decisions are made by a central national board.”
Sounds OK to me since I wake up every day with my medical decisions being made by an unseen group of insurance company executives and their friends in a previous congress that invented Medicare Part D and foisted “Medicare advantage” on us. One “central national board” couldn’t be worse than the checkerboard, hodgepodge group of deciders driven by profit motive that I need to deal with at excruciating time and emotional cost every day of my life.
I have multiple sclerosis and my medical decisions are made by all of the following: 1. Insurance companies that may or may not choose to cover the medications my physicians prescribe, 2. Physicians who may or may not choose to accept the Medicare advantage insurance I carry, 3. Physicians or HMOs that may or may not choose to accept Medicare.
Worse, all of the “decisions” are whimsical and may change at any time. Those whimsical decisions include the ever-changing Medicare Part D. I’ve just climbed out of the infamous Part D doughnut hole, having spent $4000 out of pocket to be reminded that this year the share that will be paid for my hugely expensive MS medication is only 66%. The company that makes the medication can change its price at any time. Small wonder that some are choosing to forego the medications they need.
Please, let me deal with a “central national board.”
Wouldn't it be great if ALL Americans simply stopped purchasing private health insurance? What would happen to those companies who are raking us over the coals with high premiums & outrageous deductibles? The BIG Government is going get involved in this, whether the American people want this or not. I don't want the Government taxing me AGAIN for health insurance for everybody else and that I cannot get and my children cannot qualify for. Hard-working & middle class people like myself cannot continue to support public health systems. I can't get health insurance because I have the beginnings of arthritis and I'm considered a BIG risk. OH, PLEASE! What Big Brother needs to do is reform the insurance companies. They are the biggest scams ever, bilking people and refusing coverage over simple pre-existing conditions that might cost them a little money. OMG. And what about Chris Smith's 8 year old son? Insured since birth and now dropped because they decide it's costing them too much? HOW is that fair or legal? Let's also reform what the medical facilities and doctors are charging us. I had a hysterectomy, was in the hospital 2.5 days, almost bled to death and paid THEM almost $18,000 for that carnival ride. The health care system & insurance companies need cost & coverage regulations-without sacrificing the quality of care. But what the American people don't need is more Big Government telling us we need universal heath care, and then tax us to death for it.
DD,
Thanks for your words about my plight. What is happening to my family and my son Sean is a disgrace within the borders of the richest country in the nation. Plain and Simple. Get this...
My family High Deductible Health Insurance has gone up over 120% in just the last few years. I now pay ~ $1,200.00 a month for high deductible health insurance, have a $6,000.00 deductible and a 100% payout after my deductible is met. Why 100%? An 80%/20% or 90%/20% plan would have me & can easily bankrupt a family overnight. Isn't it called Insurance for a reason? Aren't they suppose to spread the risk? As I stated before, I've played by the rules. I've paid my premiums and now they (Assurant health) arbitrarily changes my policy to fit their whimsical profit plan? How's this fair. Insurance companies and their PPO's are Corporations & out for one thing. "The Almighty Buck" Corporations number one goal is to return profits to their shareholders right? What better way is there to increase profit then to deny claims and make the paperwork a nightmare for the average parent. Conservatives for patients' rights appears to want families to spend weeks and weeks shopping different plans, critiquing bills and writing letters begging insurance companies and PPO's to PLEASE PAY MY BILL.... I'm not so sure a Government negotiated private healthcare system (Not Government Run) with pooled risk, and the goal of just healthcare is a bad thing. It's bound to be better than the BS I'm dealing with.
See you on the streets....
Chris Smith
Oh here's another great feature the PPO's and "CHOICE" get you....
The only Pediatric Urologist in the entire state of Indiana cancelled his membership with Assurant's PPO in December of 2008. Now there is no other doctor in the entire state of Indiana who can do the intricate work my son needs within my PPO.
Sure I can use the doctor who's done two of my son's surgeries before. Just now he's not in the network.
I just started my own company in 2008 and because I'm not apart of a group and on my own, this caveat about excluding mental and behavior health is an issue. Coverage for this is mandatory for group policies in Indiana but you're on your own and not covered in an individual policy aka: HSA
You'd have to be a brain surgeon to read the legal documents about what's covered and what's not to choose a plan.
How about this...
If you're a US citizen you have health coverage.
If you're not a US citizen and here illegally, get in line or get out (Government assistance provided with the boot within two weeks, sign up now or you're out)
No paperwork to file
No pre-existing conditions
No 80% / 20% or 90% / 10%
Free preventative care (Logical all by itself)
No PPO CEO's making 1.2 Billion a year (what a joke)
No Doctors or specialist making of $1 mil per year
No letters to PPO's pleading with someone who doesn't give a Rat's A_S about your health.
No doctors out of network
National Negotiated pricing for standard care
National Negotiated pricing for medications
Sounds good to me.
Chris Smith
Indianapolis, Indiana
Chris Smith,
You are right that it is national disgrace what is happening to you and your family.
Though I had it easier than you I suffered through a similar experience with my daughter who is deaf. My insurer refused to pay for her cochlear implant. We ended up winning but not without a long struggle.
And we are among the lucky ones. At least we have the resources that we don't lose everything over a health issue.
I just caught the commercial with Rick Scott on CNN. This site seems to be propped up and supported by the same people who didn't say a word about the unrestrained spending of the administration of George Bush. Bitching about government spending. Come on, guys . . . that may be the quickest flip-flop in history!
As to Health Care, supporting the status-quo will not help Americans get health care coverage. I worked for a government contractor for over five years. They changed their health-care provider three times over five years. Each time the provider was changed, the coverage dropped. I started off paying $239 monthly the first year, and was paying $355 monthly on year five. My initial out-of-pocket requirements rose from $500 for each person to $1500 each.
STOP THE MISINFORMATION! Let Obama try to fix the system, 'cause it is most certainly not working for the average American.
I’m grateful for the BBC’s reminding me of Winston Churchill’s “American’s always make the right decision...after they have tried everything else.”
It is good to see the little people contributing war stories to this discussion and turning on the vested interests the Republicans always prefer over those same little people the Republicans pretend to care so much about.
Other Western countries have found solutions to this difficult problem and, while the solutions aren’t perfect, I don’t know of any country where the masses covert the US system. How have the insurers got away so long with preferring their shareholders’ interests over the national interest? It can only be because until now, the former have been better organised. Worms turning don’t usually make this much noise.
What bothers me about so many of these comments are the people who complain about not having "choices" in there health care. Every one has a choice in where to go to get their health care. What these people seem to want is a better choice in where to spend money that isn't theirs. Why do so many people think that insurance should cover all their costs? Why should you expect to be given the opportunity to pay $100 and receive $500 worth of care. Quit asking for handouts from everyone else. The problem seems to me to be less with the insurance and more with the abuse of it and the cost of the care. Insurance is just that it's insurance you don't expect your car insurance company to pay for gas and oil changes. You shouldn't expect your medical insurance company to pay for expected expenses either. Like your auto insurance it should be there to cover unexpected emergency expenses. The rest you should pay for yourself. Believe me when the medical industry stops getting paid outrageous prices for treatment the price will come down. It has to or they go out of business. I gotta say it just gets really old hearing so many people whining "I'm sick and someone else should foot the bill."
MF
Comment: Every one has a choice in where to go to get their health care.
Really....
If you'd walk a mile in my shoes, you wouldn't be so flip about your comments. My son through no fault of his own has autism. My Insurance company (Assurant Health) (Who I've diligently and faithfully paid from $550.00 to 1,200.00/month since 1999) arbitrarily stopped covering mental and behavioral health costs. Now my son is relinquished to the role of the uninsurable. His gas & oil changes (to use your analogy) are horribly expensive. Where's my choice here? He's been covered since before he was born with this same company and they are allowed to cancel coverage just because some actuary said it's costing them money?
Are you OK with this too?
Comment: Believe me when the medical industry stops getting paid outrageous prices for treatment the price will come down.
OK Einstein.... How is that going to happen? Voluntarily? Or through the all and powerful OZ "Free Market System" Its worked really great up until now hasn't it?
Comment: I gotta say it just gets really old hearing so many people whining "I'm sick and someone else should foot the bill."
For the record I'm not a car!
What is Insurance again? Isn't Insurance there to cover expenses when you have a major claim? Hypothetically - If a company wanted to minimize major vehicle repair costs, (to use your analogy) wouldn't it be wise for them to cover oil changes, frequent check-ups, and minor repairs? To do otherwise would be short sighted and downright stupid (in my humble opinion) don't you think? With regard to Healthcare, since we ultimately cover the poor (if they want to wait long enough - right), shouldn't the people of the Commons (Good ole USA) foot the bill by spreading the risk amongst us all and cover preventative care to minimize major repairs? More than anything else, this will drive down major costs and replace the for profit cream being skimmed off healthcare by the Bill Frist's of this world with actual healthcare. What a novel concept. Helping people who cannot afford healthcare.
You clearly must be a "Compassionate Conservative" with your world-view.
I feel for those with insurence problems, I too have pre-existing health prroblems, and can't get insured, But if you think Goverment is the answer,think again! As for getting the same health care as our elected officials, Good Luck! Isn't that what they have promised? You will pay big bucks,every pay check, for your care and everyone elses too. Give me a break -do you really think BIG BROTHER cares aout you and me? Its all about controlling us. I talked to a lady from England in 92 and she said she hoped we never had to indure that nightmare-of social Med. She said it cost the people big time, and doesn't work. Even tho large sums of money was coming from her and her husbands pay checks,she was paying out of her pocket, to get good care, and when she needed it. I know your angrry but dont let it cloud your good judgement,More power to the goverment,over us is not the answer. My prayers go up for your son Mr. Smith. And that America wakes up -Goverment is not our answer.
I am a US citizen and have experienced both the Canadian and British health care systems. I spent a few years in Canada and have a son-in-law who is a doctor practicing in the USA for approximately 25 years. My former mother-in-law resides in England and does NOT receive health care in a timely manner.
For any serious health care issues, my son-in-law has his family come to the US for care because of the intolerable wait associated with the Canadian system. While in Canada, I experienced significant patient care delays because of the government prioritization of health care. Furthermore, to amortise the cost of expensive medical equipment, such as MRI machines, the equipment is shared with Veterinarians which delays such use for humans.
The bottom line in government controlled health care systems is the fact that patients are NOT the number one priority. Their care is subordinate to health care cost.
Mel Borel
The quality of health care is inferior in a single-payer system. There is little or no incentive for doctors and other health care professionals to innovate and improve therapies. We see this already in the poor care for seniors with chronic illness under in our government-run medicare system.