Rochester may have cure for health care malaise N.Y. city cuts costs, widens availability

December 20, 1992|By Ann LoLordo | Ann LoLordo,Staff Writer

ROCHESTER, N.Y. -- When Anne Lewandowski went shopping for health insurance a couple of years ago, it didn't matter that she was barely out of her teens, worked for a temporary agency or had a tube implanted in her brain.

In many cities in the country, including Baltimore, the 22-year-old would have been considered a bad risk, an expensive hospital stay waiting to happen. Insurance companies would have looked at Anne Lewandowski's medical past skeptically: Twice, she has undergone surgery to relieve a condition known as hydrocephalus, water on the brain. The tube inside her head -- a ventricle peritoneal shunt about the size of a pen -- drains excess fluid from her brain.

But in Rochester, Ms. Lewandowski's previous medical condition wasn't even an issue for insurers. And that's a key reason why President-elect Bill Clinton -- who addressed the matter again in a newspaper interview published Friday -- and others are looking to this stone-cold city on Lake Ontario for answers to the country's health-care woes.

For Anne Lewandowski, health insurance was neither unavailable nor unaffordable in the hub of George Eastman's photographic empire. It cost her not much more than $120 a month to belong to the most popular pre-paid health plan in Rochester -- the same as a healthy, 56-year-old Xerox executive or a divorced 35-year-old photographer infected with the AIDS virus would pay.

"I know what it's like to be sick," says Ms. Lewandowski during a break from her job at a Rochester area bookstore. "I know what it costs to go to a doctor. Believe me, it's worth every penny."

With Rochester, forget about Kodak's latest fiber optics technology or the Eastman School of Music's newest composer or the quickest route to nearby Niagara Falls. The news here is a regional health-care system in which the cost of insuring employees is two-thirds the national average and the percentage of uninsured about half of what it is across America, according to a national benefits consulting firm and census data prepared for Blue Cross and Blue Shield of Rochester.

"Just ask the president-elect," says Bob Sperandio, owner of a suburban Rochester mail-order firm that sells pet supplies.

Ever since the presidential debates, when Mr. Clinton cited Rochester as a metropolis that insures more people at lower costs, the question has been: Can the unique aspects of the Rochester system be duplicated across the country?

The secret is out

"We've been trying to get people focused on Rochester for a decade," says Dr. James A. Block, president of Johns Hopkins Health Systems, who led a hospital cost-containment project in Rochester in the early 1980s. "Rochester has a regional health-care system and it's obviously been very effective in not only curtailing costs but in assuring access."

It is an achievement that turns on a hackneyed concept -- cooperation. And yet the Rochester experience redefines the word.

For more than a decade, Rochester's large employers, hospitals, health planners, Blue Cross and Blue Shield and physicians have worked together to benefit employer and employee, insurer and subscriber, medical provider and patient. No small achievement in an era when Washington policy makers and corporate America urged competition as the way to improve the bottom line.

And although Rochester and the six surrounding counties have not been spared annual, double-digit increases in health-care premiums, "the inescapable fact is health care is a significantly better buy here than anywhere else in the country," says David E. Edwards, benefits director for the Eastman Kodak Co.

The region's success in controlling health-care costs can't be attributed to any one person, program or policy.

Rather, it's the product of a corporate and civic culture that has evolved over the past 30 years and promoted three key concepts: large employers buying health coverage from a predominant insurer, a "community rating" system in which the risk of insuring less-healthy people is spread across a pool that includes all insured, and regional health planning aimed at controlling hospital costs.

Add to that a philosophy of doctoring in this region of about 1 million that relies less on sophisticated medical technology than a probing bedside manner, "a culture of restraint" promoted by the faculty at the University of Rochester medical school.

"There's been a collective mind-set that we can cooperate and all win," says Mr. Edwards, of Kodak, by far the largest employer in the Rochester area, with 40,000 workers.

That mind-set was fostered to a great degree by a man who gave the world the first easy-to-use camera, George Eastman.

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