Charles Inlander Show Segment

Charles Inlander, President, People's Medical Society 1-(800)-624-8773 Peoples Medical Society, Allentown, Pennsylvania, 18102 Given: May 22, 1996 at AARP Biennial Convention - Denver, Colorado Your Rights As A Patient Health Issues “All hospitals and physicians do not offer the same quality of service. Learn how to become a more assertive patient who chooses medical services wisely.”

PRESS CONFERENCE Q: Can you perhaps recap a little of what you came to AARP to speak about? A: I came today to talk about patients rights and the rights of consumers, particularly these days as the health care system is rapidly changing from a ......service, choose any doctor you want system into a very corporately run, managed care type of system which puts a lot of strain and lot of concern on consumers about what their rights are and their ability to get various issues resolved.

Q: Can you give us a little retrospect on what's going on in the last two or three years? Let's say the high point was the Hillary Clinton health care episode and the awareness from that. What's gone on? A: Well I think that actually the defeat of the Clinton Health Plan or the fact that it never was voted upon or implemented turned out to be a negative in a lot of ways to the health system because it allowed health care corporations, big managed care companies, and others to devise their own means of providing health care. They're doing it at a, in a very corporate way which is to say that greed is driving the system more than care and compassion is driving the system and while on the surface it appears they've been successful in keeping costs down for large corporations, the reality is that health care costs are still double what the rate of inflation is, that the number of uninsured has growth from 37 million to 42 million since the health care plan was defeated and that most consumers are in absolute chaos and fear of what the health care system may be given the fact that it's going to be and being run by profit making large insurers rather than something that's more of a relationship between a consumer and a doctor.

Q: Has there been any change in focus on people medical society from say, I know malpractice is a big issue and discovering doctors competency was a big issue but now some of these corporate issues, what does ...... A: Well our major issues have always been to get information to consumers about health care so that they can make better health care decisions which means that we push very very hard for mandatory disclosure, legislation and trying to get consumers to be more alert to asking doctors questions so that you can get information to make decisions about. We've always been concerned about the health care system itself and so the Managed Care Movement which we support, we think Managed Care is a good concept. What we don't support are greedy and bad Managed Care Companies, those who are lining their pocked off of a system that isn't necessarily delivering good care. Our focus has shifted somewhat into that area. Into helping consumers learn how to deal with companies rather than individual doctors and how also to get their doctors to be more responsive to them because now the doctors are responding to those managed care companies and not to their patients, and, in fact, they're blaming managed care companies for their bad actions when the doctor may be just as much to blame. For example, it's doctors who are kicking women out of the hospital earlier, not managed care companies. Doctors have not stood up to their own managed care companies to say, "I think a patient should stay in longer." Instead they blame the managed care company when in reality, doctors are doing it themselves. So we're looking at those kinds of issues, we're standing up and trying to help educate consumers about what they can do to protect themselves.

Q: I think President Clinton made that an issue just in the last week about mothers being expelled too early. ... I was saying about President Clinton's recent action, can you give us a little opinion or background on what he was trying to do and what that might and how long it might take effect. A: Well the President was responding to this call, it's going through the states and legislation is being passed in many states that will require managed care companies to allow a woman to stay in the hospital two days after giving birth for a vaginal delivery and a certain number of days longer for a cesarean section. I'm very much concerned about that kind of legislation because I think that's skirting the real issues. The real issues are not whether someone gets a day or two in the hospital. What's two days? Is it a magic number, no, it's not a magic number. Some women should stay three days, some should stay four, some should go home in two hours. What these folks are doing in Washington and in the states are passing minimal legislation to try to get a lot of credit for passing big time legislation and this isn't big time legislation. What they're doing at the same time is trying to gut Medicare. They're trying to cut back on Medicaid by giving it to the states and letting the states gut that. They want to take away rights that have been hard fought and won in the nursing home rights protection area. They are not looking at the major issues. They're, the unemployed, the uninsured people in their state are growing in big numbers and they're not introducing legislation to take care of that and so to take on these, these, these small minor issues, and they really are relatively minor comparatively, is wrong and is a way that the politician can run back to the constituents, constituency and say "Look what I did." So I'm, I'm, I'm pleased that they're concerned about certain types of health issues, but this is really disingenuous and I just don't think that they are really looking at what the critical point is in this country and that is that they should be looking at the payer system, they should be looking at the quality system, they should be looking at the access issues because those are much bigger than a day extra in the hospital.

Q: Can you give us any prognostication over the next sort of political hump we have here, we're in a Presidential year and we know there's been this, sort of, uproar in Congress whether it's a revolution or just what and we've also noticed that certain things have come to a grinding halt. What is your best crystal ball as far as where politically it's going to go as far as medical issues? I think that there's not going to be a lot done in the next year on medical issues because of the election. I think people are afraid to make health care an issue after what happened after President Clinton was elected. But I think that after the election, the real issues of health care are going to come back right in the face of Congress and that is not so much just the cost issue which is always going to be there, but the uninsured issue is going to grow. By the year 2000, we're going to have 50 million uninsured Americans. This is abominable. This is a horrible situation. Baby boomers who are now just turning 50 are going to be closer and closer to moving into Medicare age and are going to be using nursing homes and those kinds of things. The issues are only going to get greater, so we have to look at the broad system. We have to look to see that the health care system is being expanded and recognizing that we're having a growing demand on the health care system and we have to face that and I think that it's going to come down to a single payer system. I think that within 10 years, by the year 2005 or so, that we are going to be seeing the beginning of the implementation of a full single payer system in the United States because it's the only way we're going to be able to assure access, and assure coverage and it's going to be demanded by the public and by business by the way. I think business is going to say, "Get me out of this. I can't try to do health care anymore."

Q: You may have noticed that AARP announced an endorsement or certification system I think for HMO's. Yes.

Q: Do you have any reaction to that and does, can AARP play a role in private insurance or privatization? Well I think that AARP is an insurer already and they're a player in it through their contracts with others so they've got a conflict of interest that way. I don't believe, and it's fine that AARP is going to endorse by whatever standards it wants to establish but I don't think consumer organizations should endorse health care providers of any type or insurers because that creates a conflict of interest. It basically says to its members and others that this is a good organization and you should join this organization but if something goes wrong later, one has to start to question whether AARP would pull out of that endorsement or any health group. So I think from an advocacy perspective it's a lot better if there are more organizations that don't endorse but are watch dogging and are looking and are speaking about the good things that are happening and are also pointing out the not so good things that are happening. So, I mean, for AARP it might be fine, they're already doing it to a certain extent and I don't know whether the public will see this as being a tacit endorsement of great quality, but I think they have to be careful no matter who endorses it, we always have to be careful that conflicts might be coming into this play and the fact that they might be receiving fees back for doing it is something else that creates, as a consumer, a skeptical question that you should always ask.

Q: OK, so in other words, just looking the basic facts in the fine print or reading the newspaper stories on just what, how, how that might fall, is being a good consumer. Oh absolutely. You should always be looking yourself. I mean the fact that, you know, there's lots of motels I've driven into that's got an endorsement by AAA or something and I go in there and it's not so good may have been a while since they were in there so, you know, you have to look into these things yourself. Those, those endorsements may be another thing you use, they may be the reason why you start to look at a particular HMO, but they shouldn't be the reason you pick the HMO, they should just be another bit of information. You've got to go into that HMO and ask questions, you've got to see what their record is in terms of the problems you may have, you've got to see if you can live with their rules, you've got to see if they're the kinds of doctors and hospitals and nurses that you'd want to work with.

Q: Now we're, we're from the Detroit area and we have several large medical facilities and we, we seem to notice a trend especially since we're sometimes recipients of a PR effort. The health care system will call us up and say, "Would you like to know what latest sort of retirement village we are now, have built and are now staffing." and we're noticing the name changes, softer names. Henry Ford Hospital is now Henry Ford Health Care Systems and so forth. Do you have any suspicions about this or is this kind of a national marketing move or what's your comment on that? Well, yeah, I mean, it's a marketing, this is all marketing. I mean, remember that, the old days it used to be the hospital for sick children, the hospital for the poor, this sounded too harsh and so they gradually changed it to, you know, a name of some other sort. Don't believe the hype. Don't worry about what the name of it is, go in and look at what the quality is that, that's the important thing. You can drive along the street and se St. So-and-so's Hospital, that doesn't mean that it's blessed. These, these places are all health care organizations that do some good things, may not do some good things otherwise so you've got to check those things out but no question about it, the health industry is over represented in this society. It's the largest business in America, the health care industry. Half the hospital beds in the country are empty. Half the hospital beds are empty. A third of the hospitals in this country could close tomorrow and have no ill effect on health care and so, and we have a glut of doctors. We are over doctored in this country. We have a glut of, of, of other types of providers so these are, this is, these are last gasps of dying men trying to stay in business. Changing their name, changing their image, changing their practice, an individual doctor's practice becomes the Knee Center. These things, don't, don't, fall for the hype. Don't fall for the title. Don't fall for the, the, what they say, go in and see what they do. Check it out before you buy, buy the title.

Q: Do you think there are going to be some natural market pressures that are going to close down and eliminate.......or at least of number..... Oh absolutely. I mean, the hospital beds, in ten years we're going to see a third of the hospitals gone. They should be gone. We're going to see probably 25% less surgeons because we're replacing surgery with, with medications, we're replacing surgeries with laser kinds of treatments and laprascopic type of treatments that technicians can do that we don't need surgeons to do. We will see, we're going to need probably half of the primary care doctors that we need because nurses, Advance Practice Nurses are as well trained as a primary care doctor to do most of those things and the technology is coming along that we're going to be able to do a lot of this ourselves. The real revolution is the technological revolution that's occurring which is bringing health care into the hands of consumers that is making the, the need to have a 400 to 500 thousand dollar trained doctor doing minimal and primary kinds of things absolutely obsolete and way overpriced to do that. So, indeed, this is going to be a major changes and that's going to drive where the health care system is going much, with a big fight though. I mean, believe me, the health industry and the docs are going to fight this down tooth and nail but they're going to lose because inevitably they will lose. It's just that they're going to extend it longer than it should be but they will lose because we don't need them in the way we've needed them in the past.

Q: You're saying this is a good thing. This is not going to be detrimental to our..... No, absolutely this is, no, this is wonderful stuff. I mean, the fact is that we can have more people doing things. There's 11 million nurses in the United States, there's only about 200 thousand primary care doctors. I mean there's, we can have nurses doing primary care in the most rural sections of the country. Think of technology. We can have about 20 drugs represent about 80% of the, of the prescribed medications. Those can be dispensed by ATM machines using Smartcards. Therefore, people who live in the middle of nowhere who can't get medications easily can take it to an ATM machine, stick it in there, and their prescription comes out with information about how to use it and its problems. You don't get, in some places, you can go on a Sunday then, you can go 24 hours a day. The technology is amazing that's coming along. It's out there for most other kinds of services. It can be applied to health care and that's good for consumers because it puts us in control. It gives us the information and the power to do it. We are very good medical providers to ourselves. 85% of all the health care in the United States is self care and we do a good job of that. We take care of our first aid, we take care of our minor aches and pains, we use over the counter products very responsibly. The 15% that we have to go outside of our own home to do, costs us 14% of the gross national product. The other 1% is what we do for ourselves and we do that better than the health care system does for the 15% that they provide us. So, indeed, the more we get this way the better it will be.

Q: Now speaking of pharmaceuticals, there's always been a debate between whether you should pop a pill or change your lifestyle. We've noticed in the older, you know, older level groups there are certain things that sort of creep in. Everyone, obviously, needs glasses when you're over 40. There's a big push towards cholesterol and blood pressure medication which I would assume is a multi-billion dollar and I .....even personally, doctors are prescribing, "Oh yeah, we'll put you on, we'll put you on a blood pressure or we'll put you on cholesterol lowering." whereas there's a whole body of nutritionists who say, you know, you can eat healthier and you can exercise.... A: We're doing, but we're doing both. Both is being done. Look, we exercise and fitness in this country is at the highest level it's ever been in terms of people going out and doing it. That's not driven by the health care system, that's consumers who started it and then the health care system comes along and decides to make it a disease. You've got exercise physiologists and everybody else involved. The medications are being prescribed more and more because the problems are more and more. We have more heart disease, we have more high blood pressure. You know, lifestyle changes don't solve all of those problems, they help and so people are, most people are doing both. They're trying to cut down on their cholesterol if that's a factor, they're trying to eat less, but just as we've learned in recent days, you know, now, all of a sudden, salt is no longer a problem for hypertension. You know, we find that, we've just got studies that show that fat intake is not a cause of breast cancer. In fact, certain types of fat seem to be protecting women from breast cancer so the information is changing all the time. The lifestyle changes that we make are reactions to other things that we hear but many of those things change. Medications are out there, they're there to be used when they're appropriate. It's up to you though, as a consumer, to think about what you can do but not to pass up medications when they're available and they're useful and they're helpful and they can enhance your life or save your life.

Q: So is it, is it ever too much or is there, can a consumer really cope with it. It seems to be information overload but what are some good channels. Well, there's always too much if you try to learn everything. You can't learn everything. This is the best era ever for consumers and it's only going to get better because the more information available, the better it is for you to be able to make decisions. You're not making blind decisions, you can be responsible for what you want to do, and then you can make the choice if you want to follow it, fine, if you don't want to follow it, don't follow it. So I think it's very , very, the, it's only getting better for consumers.

Q: What can you tell us about the People’s Medical Society? Is a way to get in touch with you? Well we're the largest consumer health non profit advocacy group in the country. We have a newsletter you get for membership and we have several other newsletters you can subscribe to beyond that and we're one of the largest consumer health book publishers that we give you discounts on our books like take this book to the hospital with you and other books. You can call us at 1-800-624-8773 or you can just write to Peoples Medical Society, Allentown, Pennsylvania, 18102.

Q: OK and one last question. We seem to be seeing, and this is along the lines of media awareness or consumer awareness, we seem to be seeing some pretty scary hospital shows on television and whether these are reality based or a lot of people come away sort of shaken by the episodes they see . Do you have any comment on the awareness factor and how it affects them? Oh I think these shows are great because I think what they do is they, they cause people to ask questions of doctors, they ask them about Emergency rooms, they ask them about hospitals and hospitals are forced to respond to either say, "Well it's not like that at our hospital." and show that it isn't, or that it is like that. But you know, it's interesting because I don't think any of these hospital shows have really gotten down to the big issues yet. In fact, the old show, St. Elsewhere got into some of the bigger issues just ironically but it doesn't necessarily make for good TV so, so, but no, I think all these shows are good and I think that just as police shows brought the world of police to the public to understand the two sides of things, so do these medical shows but the reality is, they're entertainment and so a lot, a lot of license is taken with what goes on but no I think they're great and they put the profession on the line.

Thank you.