Health care blues
Your cover article from the August 3 edition (“Ouch Says The Wallet”) was a very interesting account of how patient advocate Mike Dostrow, formerly a practicing physician, went before the Hospital Board of the So. Mono Hospital Dist. and brought the Board’s attention to the fact that medical procedures, especially surgeries, were available around the state from different kinds of institutions at wildly different prices.
He noted that a particular surgery could be obtained from a surgical center in Redondo Beach for a third of what the same procedure costs at Mammoth Hospital.
The hospital’s chief financial officer, Melanie Van Winkle responded that, of course, there was going to be a substantial price disparity between a regular business-hours only assembly-line surgery shop in a huge population center versus a 24/7 hospital facility in a small town in the mountains. These are important things to think about and I am glad the Sheet printed the detailed discussion, as health care and its costs are important to all of us.
However, it could be argued that the article raised more questions than it answered, not because the article wasn’t well written, it was; but because the subject is so complicated.
While I am not a medical professional, I’m just a consumer, the first thing that occurred to me was that, to a certain extent, there are three groups of us consumers in this discussion; those of us lucky enough to have medical insurance, in which case the price disparities are much less important; uninsured consumers who can’t afford any surgeries and so don’t really spend a lot of thinking about the cost at all; and finally, uninsured consumers who do intend to pay for any medical care they receive and therefore spend a great deal of time thinking about health care costs. Sad to say, the system we have now works such tremendous inequities and unfairnesses on that group, it is a very small group, indeed.
Notwithstanding that the third group is a small one, it is kind of a bellwether for all the problems with our health care delivery systems in this country; whose cost has exploded to the point where we now pay as much as twice per person for health care as the next most expensive country, with outcomes that are only half as good.This cost is forcing employers, who in the past provided health care to their employees as a matter of course, to require those same employees to pay a much greater share of health insurance premiums, or to simply cancel employer-paid policies and allow employees to fend for themselves.
Medical bills have become one of the leading causes of bankruptcy filings over the last ten years. The explosive growth of the uninsured has even caused the passage of Obamacare, which has become the subject of so much controversy that, just a couple of days ago, former presidential candidate Newt Gingrich excoriated his own party for being virulently opposed to Obamacare but not coming up with a viable replacement. Obviously, when faced with exploding costs, the biggest question is “who’s responsible for that?” While fingers could be pointed in every direction, Mike Dostrow focuses on the insurance companies’ contributions to our misery. He details how they negotiate big price reductions with hospitals and then refuse to pay their own “negotiated” prices. He explains how their claims procedures are so byzantine they cost more to comply with, then to do the medical procedure in the first place. He then suggests that hospitals have a “universal” price for the same procedure in any hospital to deal with insurance company practices and competitive pressures.
So, apparently, in Mike’s world, some federal board would decide what a hospital, public or private, could charge for a particular operation. Price fixing on a grand scale. For reasons too numerous to mention, I doubt that such a scheme could ever come to pass.
More practical, however, is his suggestion that there be universal claims forms. We already have precedent for that in the forms for mortgage loans that are approved by Fannie Mae or Freddie Mac and the insurance policies that are approved by state insurance departments. The companies may vary but the forms and the language are the same. That is a terrific idea that I am sure the insurance companies would fight to their last breath, since it would remove a lot of the mystery from the whole process.
The bottom line is that we all have to take responsibility for our own contributions to the problem, realize that we like having unlimited health care if we have insurance, but hate the idea of not being able to afford that insurance when the price goes up (and up and up). We also have to come to grips with the idea that maybe health care shouldn’t be unlimited (“death panels”!), or maybe we have to consider a single-payer system seriously if the cut the insurance companies take is too high or the service they provide is too low.
Even more controversial, a two-tier system, where universal medicare provides a basic, limited level of care and you pay for a policy that gets you more cutting edge medicine and a nicer room. All these solutions are on the table; now the challenge is to separate the facts from the politics and make wise choices. No easy task in this world.
More Mammoth machinations
The following two letters were addressed to Mammoth’s Town Council and cc’d to us. They are in regard to rampant rumors that Council may make a Town Manager change.
Mayor Wood, Town Council:
In recent weeks you’ve had several discussions in closed session evaluating Town Manager Marianna Marysheva-Martinez, all while she’s been away on a family vacation and could not respond to your discussion. And now I understand you plan for a final closed session discussion/vote this Friday in another closed meeting during which you will likely dismiss her. Furthermore, word has it you also plan to replace her with a local businessman and personal friend to several of you, who arguably lacks qualifications or the appropriate experience for a job this critical. Could this really be true?
I am writing to you, as are other Town residents, to express considerable alarm and extreme disappointment if this is, in fact, your plan. I truly pray it isn’t, but if so, and in danger of appearing disrespectful, seriously, what are you thinking?! Or worse yet, secretly conspiring to do? All in closed sessions lacking transparency, ethical employment practices, or public understanding? As with my recent experience concerning other secretive Town plans, I’m wondering who you may really be working for, or in the interest of … ?
While possibly not directly related, it appears your current evaluations of Ms. Marysheva-Martinez’s job performance began following another recent closed session decision surrounding the Town’s hushed plan to purchase (with public funds) the Mammoth Firewood lot for Waste Connections Inc. to site/build a regional waste materials reclamation/processing facility (a.k.a. “materials recovery facility” or MRF) in the Industrial Park directly adjacent to recreational facilities and nearby homes. Disturbingly, this secreted [sic] plan has been driven by several council members and staff without public process or even basic public awareness. And while the closed session discussion to purchase the property resulted in “no action taken,” likely following a 2-2 vote with Mayor Wood abstaining, I expect this plan to be revisited soon, driven by continuing pressure from Waste Connections. And I think it’s possible you’re planning for a revived discussion and another secret vote once the Manager is dismissed, or maybe you’re even planning to hold this on a date when an opposing council member can’t participate… this wouldn’t surprise me given what I’ve already witnessed.
From my personal experience participating in Town meetings and directly communicating with the Town Manager regarding her predecessor’s plan with Waste Connections (as you’re aware, I’m a long-standing member of Mono County’s Solid Waste Task Force), I found Ms. Marysheva-Martinez to be very professional, extremely intelligent, driven, highly qualified, capable, and committed to ensuring an open public process for ongoing MRF planning. Above all, however, I found Ms. Marysheva-Martinez completely dedicated to straightening out the mess that is Mammoth’s government. Understanding this, I also know why some town staff, council and other influential locals who are/were part of that mess have continually persecuted her.
Since I moved back full time to Mammoth in late 1999, the Town has employed at least five town managers, with several spectacular, memorable failures, all hired by Town Council. How much has this revolving door truly cost the Town socially and financially through ineffective, distracted and questionable management (i.e., the airport decision), not to mention expensive severance packages? Town Council must step aside and stop its habit of micro-managing, and instead allow the qualified person you hired to do the job an opportunity to really do it. Ms. Marysheva-Martinez was recruited when the Town desperately needed someone with proven experience and ability to guide us through impending bankruptcy. She did that and now we’re on the other side facing years of paying off a huge debt she had no part in incurring, while some of you did. I also understand she likely upset a few of you by committing to a transparent, public process in future MRF planning.
In light of today’s historic date, I, too, ‘have a dream’ that our embryonic little town might actually evolve into something we’re all proud of. It has incredible potential, the reason many continue to live here and remain actively involved. Maybe it would be best if we stopped replacing town managers and instead replaced historic town council. The definition of “crazy” is understood as repeating the same thing and expecting different results. As it is, the Town appears as a poster child for this definition.
Thank you for your time and consideration.
Dear Mayor Wood, Councilmembers,
Is it true that our current Town Manager may be terminated and replaced by a long-time local business owner? If so, why?
Please don’t make this hasty decision. Eight Town managers in 19 years makes a revolving door a more suitable brand for Mammoth Lakes.
With crippling layoffs and remaining key personnel leaving for better positions elsewhere, a serious evaluation of the kind of team the Town requires to move forward should come first.
If you are unhappy with the current manager’s performance, then openly seek and recruit the very best professional candidate, a person trained in municipal finance, an effective team leader, efficient manager and experienced negotiator. Chess moves in closed session will not produce the best-qualified candidate.
Mammoth Lakes is at a critical juncture. Will we compete successfully with our peer resorts for vacation dollars or continue to be the weekend “swap meet” of outdoor recreation? The Town Manager position is too important for our community’s future. Don’t rush it.
If the rumor is true, rather than being abruptly terminated, Manager Marysheva-Martinez could be extremely helpful with recruitment. She was hired because of her financial expertise with municipality budgets. That experience is vital considering what the Town continues to suffer since the settlement of the lawsuit. What she uncovered regarding past practices in the Finance Department was stunning. She has been organized, efficient and accountable. These qualities are the foundation of effective leadership.
Please reconsider this decision very seriously.
Save the meadow!
The next Mammoth Lakes Planning Commission regarding the proposed subdivision and further development of the meadow [at the entrance to] Tamarack Street is set for Sept. 11.
At a previous meeting, the property owner, Mr. Danhaki, stated that if the subdivision were approved he would putninto title the preservation of the rest of the meadow. As of this date, as far as I’ve been told, minimal effort has been undertaken by the owner to achieve this protection for the meadow and wetlands.
The owner also stated that if the subdivision was granted he would remove the current barn/tack room/apartment on the 2nd parcel and, keeping the same building footprint or perhaps enlarging it by a small amount, build a single-family home on the already-disturbed site. If these things are done as stated and the proposed house is 3,000-square feet or less, we (my wife Denise and I) would drop our opposition to the subdivision and support the property owner’s efforts. However, we don’t see any significant move towards this happening.
So once again, we are asking our friends and neighbors to rally to preserve this meadow and open space in our town.
Please attend the Planning Commission meeting on September 11 and voice your opposition or concerns.
Also please submit letters stating your concerns to Town Associate Planner Jen Daugherty and Planning Commission members Elizabeth Tenney, Rhonda Duggan, Mickey Brown, Colin Fernie and Dave Harvey.
If you have any questions, feel free to call me @ 760.934.6586.