By Christopher Guadagnino, Ph.D.

Published January 1998

DISCUSSION FORUM

• Jon Fox deserves support

• React to this article in the Discussion Forum.

PND: Why are you running for Congress?

MB: Over the last 28 years of my health care experience, I’ve gone from being a nurse to a nurse educator, patient educator, nurse practitioner, medical doctor, ophthalmologist. Then as a co-founder of a physician owned and run insurance company—Pennsylvania Physicians Care—I have found that I can no longer take care of patients the way I think it needs to be done. We used to have a patient-physician relationship. We really now have a patient-insurance company relationship and the doctors are on the outside looking in. Now I have to actually get around hurdles to do what I need to do to take care of patients in a quality fashion.

PND: Other physician leaders have attempted to address this problem in variety of ways. Why run for Congress to do it?

MB: We have done that first part and it’s working well and going well in Pennsylvania, but unfortunately, major health care decisions are made by the United States Congress. Right now we have very few physicians at the table making those suggestions. I believe it takes physicians taking care of patients to get an idea of what the logical options are to give good quality health care. It’s reasonable to take physicians who have had some business background to understand how we can work together with businesses in the private sector to make this work.

PND: What are the main issues you’re going to run on?

MB: Number one issue is going to be health care needs from when you’re born to when you die. Congress needed to pass a law saying new mothers can stay in the hospital for more than 24 hours. I think it’s good that they did that, but I think it’s a failure of the health care system that they needed to do that. What we really need is some Congressional direction to keep the insurance companies in line so that our quality is not decreased. I really don’t think that individual medical decisions should be decided at the Congressional level, which should be left to what doesn’t get done that must get done. On the issue of reproductive choice, I am pro-choice. I’ve seen a child die from a back room abortion and I’m not interested in putting up any hurdles that in this United States we’re going to encourage that. I don’t love abortions. I probably wouldn’t have one, but I do think that we need the ability to choose. The best-case scenario would be it’s not at a Congressional level, that it is between a physician, the patient and their family. Certainly there’s a question if we should have funding for abortions. I would have to say that if we don’t provide reasonable funding, then there’s a section of our population that doesn’t have the choice. I am very much in favor of breast cancer research. Unfortunately, our current Congressman actually has voted against breast cancer research and I wouldn’t do that. I see that, not as a women’s issue, but a family issue. Anyone that’s had breast cancer knows that everyone is affected. It goes right up to long term care: right now our senior citizens have to almost go bankrupt to get long term care and that’s going to become a huge problem.

PND: When would you regard it as inappropriate for Congressional regulation to determine health care matters?

MB: Congress is always where the buck stops. So if these decisions aren’t made at the other levels, they are going to need to make them. It would be individual medical decisions that I would prefer to have. The abortion issue is always going to be at some level of government because of the funding. Right now I see the for-profit agencies directing what is quality based on the bottom line. We have a number of for-profit agency medical directors as the physician input into the NCQA, National Committee on Quality Assurance. I see that as being very incongruent. I don’t think I want the medical directors of insurance companies being the ones who are setting the quality standards.

PND: What would Congress’s role be in setting quality standards?

MB: Congress could set up a variety of incentives and get physicians together to set up some of the standardized terminology so that we could begin to put together, using statistical packages, some ways to determine quality without large federal studies. Federal studies are very expensive. If we had standardized terminology we can use all the studies going on across the country and put them together reasonably and for very little cost.

PND: What is your view of reducing regulatory obstacles to physician network formation?

MB: We could put up incentives, given that there are safeguards, that allow physicians to work in larger groups. If you have large groups that have reasonable medical information systems, enough to do the job right, then I would like to see physician groups working to take risk and actually cut out the insurance company. But it has to be done carefully and correctly so that they have adequate MIS systems. You have to safeguard the patients in that regard.

PND: What obstacles exist now that could be removed to facilitate the formation of physician-sponsored groups?

MB: I think we have insurance lobbies right now so that HCFA and other government agencies are not allowing physician groups to take on risk. So we need to have the regulations that will allow them, but we have to be able to assist them to maintain good information systems. Those are costly. We need to see if we can turn around some money into that area so that those systems can be created and shared. That can be incentives in reimbursement. Certainly we don’t need large government agencies, but just a stimulus, even a small group, to begin to pull the private sector together to try to get people to work together. We can link some of these physician organizations across states with good information systems. We still have a lot of waste in Medicare and we’ve got to get the people who are familiar with medicine, with the different aspects of health care, nursing, home health, as well as some expertise in business to see how those pieces fit together and get to that table.

PND: What is your assessment of the future impact of for-profit HMOs on physicians?

MB: With a lot of managed care organizations there’s no question that increasing market share is becoming more difficult, so the only way they can get their profits back is to cut what they give out. At some point, they are going to cut below what is quality, and they’re not going to be able to cut any longer. I believe that the large for-profits will be forced, because of their shareholders’ demands, to move out of the health care system and into another area of insurance where they can make their profits. Unless we have something set up with physician-owned and run companies, or physicians taking risk in a safe way, we’re going to end up with a huge problem for which the federal government is going to have to come up with something quickly. My concern is that they would start looking to the single payer system. Certainly you may have less paperwork, but I just don’t think the American people will tolerate hitting sixty and if you need renal dialysis, you die because you don’t get it. I think that their quality is going to be higher than what’s out there in a single payer system.

PND: How will your campaign attempt to defeat an incumbent?

MB: I’m trying to defeat an incumbent who had the tightest race in the United States last time. I think Jon Fox does not have the confidence of his voters in his ability to be a real leader. He has run over twelve times and he’s never gotten over 50 percent of the vote. I appreciate his work in the public sector in being a servant of the voters of Montgomery County. I just think that, given that I come with different sets of experiences, it makes me a different candidate who will instill confidence in the voters that I’m a leader and will be able to go further in Washington. We need financial support from the physician community—notorious for being non-participants in the political process—but I will be very surprised and disappointed, frankly, if physicians don’t see that the future of how we’re able to take care of our patients is really on the line in the next few years and that the practice of medicine is changing quickly. Physicians have come on board before when we needed them. We raised the money for the insurance company when people didn’t think we could because they knew it was important.