The debt-reduction threat to health care

THE MIRROR image of "Build it and they will come" ("Eliminate It and We Won't Need It") seems to be the idea behind many health-care proposals suggested as part of D.C. deficit-reduction negotiations.

Proposed Medicare cuts will hurt patients, doctors, and hospitals in the region and the state especially hard. Pennsylvania is one of the oldest states in the union, and we have the third-highest percentage of residents who are covered by Medicare. The needs of older adults, who typically require about double the health-care services used by younger people, won't go away just because Medicare funding has been slashed.

Pennsylvania's doctors are aging, too. About one in four is 60 or older - and we're counting on the many physicians educated in the Philadelphia area to replace retiring doctors and address physician shortages here and across the nation. Of the nation's 11 top life-science centers, Philadelphia's medical schools graduate the most medical degrees per capita. Debt-reduction proposals would cut payments to the region's teaching hospitals by nearly $250 million in 2012 - and $2.6 billion over the next 10 years- putting jobs and our future physician workforce at risk.

According to a study commissioned by the Kaiser Commission on Medicaid and the Uninsured, proposals to turn Medicaid into a block-grant program would reduce by about 30 percent the federal contribution to Medical Assistance, Pennsylvania's Medicaid program for low-income children and families, the disabled, and the elderly. Hospital payments also would be cut about 30 percent.

These massive reductions come at a time when the number of people who rely on Medical Assistance for health coverage is growing significantly. Enrollment in the region has increased by nearly 20 percent since the beginning of the recession. Statewide enrollment is expected to increase more than 20 percent as a result of health-reform measures designed to expand Medicaid eligibility.

Meanwhile, as a result of this year's state budget cuts, hospitals are already being paid 4.5 percent less to take care of patients who have Medical Assistance.

Cutting Medicare and Medicaid won't eliminate the need for them. It just shifts the burden and costs to others, especially hospitals and emergency rooms that will end up caring for larger numbers of patients without adequate insurance, or without any insurance.

As noted by credit-rating agencies, such huge cost-shifts would jeopardize hospitals' long-term financial health - and threaten their mission to provide care to the most vulnerable among us.

With nearly one in three already in the red, can hospitals in southeastern Pennsylvania continue to serve their patients and communities, support one in 10 of the region's jobs - and withstand big payment cuts?

The U.S. hospital community understands the need to contain health-care costs. Hospitals are doing their part by contributing, by accepting lower Medicare payments, $155 billion in reductions over the next 10 years. Pennsylvania hospitals' share of these cuts is $9 billion.

Hospitals are working hard to achieve savings that will compensate for these losses. They are transforming the way health care is delivered, improving quality and the coordination of care to achieve the best possible health outcomes as efficiently as possible. These changes aim to reduce health-care costs, not shift them elsewhere.

As negotiations on the debt ceiling and deficit reductions proceed, hospitals are asking Congress and the president to consider that what they cut now, they will pay for later - in more uninsured and underinsured people, in sicker and less productive citizens, in physician shortages and inadequate health-care capacity, and in lost jobs.

Hospitals have embraced the challenge to improve health and health care and reduce costs.

Many of the deficit-reduction proposals now under consideration would defeat these efforts before they have a chance to achieve results, weakening the health-care system we are trying to improve.