State can't afford prescription drugs

March 25, 2001|By Barry Rascovar

AS LEGISLATORS in Annapolis try to fashion a prescription-drug subsidy plan for needy seniors, much of Maryland's health-care system is starting to approach Code Red status.

That's not surprising, since America's health-care network also is nearing collapse.

The system's crumbling, but not enough politicians in Washington have the courage to fix it.

Especially not conservative Republicans and their anointed leader, George W. Bush. Their free-market ideology discourages talk of government intrusions into the private health-care field. That means only modest action to help America's elderly poor pay for increasingly unaffordable drugs.

Into that void now steps the Maryland General Assembly. Members are marching toward quicksand. There's no cheap solution. And yet once Maryland sets itself up as a major prescription-drug partner, it may not be able to drop this commitment.

Indeed, pressures will build on the other end for more state subsidies so Maryland can shoulder a bigger financial burden and enlarge the pool of participants.

Even an aid plan to fill the gap till Washington approves a prescription-drug bill could be illusory. Washington may never act, and even if it does, a Bush program won't be comprehensive.

At that point, state lawmakers, and the governor, will be boxed in.

A $20 million subsidy this year and next could rapidly rise many-fold later on. Yet the state is in no position to underwrite another expensive service.

It already is up to its neck in dreadfully underfunded health-care programs.

At the moment, Maryland:

Can't find the money to stabilize a mental-health network tottering on the brink of collapse.

Can't find the cash to reimburse support workers at overburdened nonprofit centers for the developmentally disabled even at minimum-wage rates.

Is struggling to find money to keep the state's famed shock-trauma system from falling apart.

Is threatening aid cutbacks to nursing homes that already are on the ropes.

Watches as its managed-care program for the state's poor self-destructs.

Fails to act as its fee-for-service physician-payment program for the poor chases doctors away with its abysmally low rates.

Meanwhile, Maryland's hospitals are squeezed so hard by state regulators that quality of care for patients soon may be affected.

The latest figures on Maryland hospitals are especially alarming. One-third of them lost money in 2000. Even worse, in the final quarter of 2000, 40 percent of the state's hospitals showed losses.

Profit margins for hospitals in that quarter dropped to 1.6 percent -- not nearly enough to keep pace with medical inflation.

The trend line over five years has been steadily downward. And it's likely to continue.

Yet the regulatory board that sets hospital rates has proposed a niggardly increase of 0.5 percent.

A bad situation will get worse.

How are hospitals supposed to pay for their own rising pharmaceutical costs; for the higher pay it takes to lure nurses in desperately short supply; for the large number of uninsured Marylanders treated at medical centers?

Remember, these are not-for-profit hospitals. Whatever surplus is generated gets ploughed back into better equipment, new facilities, more research and improved community services.

The problem is that regulators are focused on squeezing the bottom line to near-zero. Quality of care or service to the community isn't in their formula.

That's a recipe for disaster. But politicians in Annapolis aren't willing to fix this twisted, bureaucratic view of medical reality.

So hospitals edge closer to the precipice. Community outreach, including psychiatric clinics, could suffer. Beds will remain empty -- while patients jam emergency rooms -- because there's no money to attract the few remaining nurses. And patients will feel more like cattle herded into stockyards.

The same is true on the federal level, where bureaucrats and politicians obsess on keeping Medicare and Medicaid costs down -- even if it damages the quality of medical treatment.

There is enormous discontent with this nation's health-care system. And there's growing anger among state legislators in Annapolis with the governor's callous inattention to what's happening in his own health department.

But lawmakers don't control the money that could rescue imperiled medical programs -- the governor does. Yet now they want state government to jump into the highly expensive prescription-drug controversy. That may be a bridge too far, especially in a state that hasn't faced up to its other health-care obligations.

Barry Rascovar is deputy editorial page editor.

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