A Healthier System
Dr. Charles Skiba, Jr., shares his plan
by Mark Rebernik
The raucous debate over healthcare reform has faded, along with any hope of a resolution before the next election. Meanwhile, the nation’s healthcare system, that ailing leviathan cobbled together over many decades, just lumbers along without any clear guiding principle or direction. The whole debacle has been the grist of many interesting conversations with my doctor, Charles Skiba, as I lay on his examination table.
I feel compelled to pass on what I learned. A well-informed public must join in the healthcare debate. Otherwise, their interests will be stifled by the more powerful competing interests of business and government.
Skiba eagerly shares his provocative insights into our convulsing healthcare system from a doctor’s point of view. Los Angeles-based Dr. Charles Skiba, Jr. has been a practicing physician for twelve years. He received his medical training at Michigan State Osteopathic School of Medicine and completed his residency at Northwestern Hospital in Chicago. Dr. Skiba is board certified in family practice and family medicine and is credentialed as an HIV Specialist by the American Association of HIV Medicine.
His views emanate from a fundamental premise. “Congress,” he contends, “has ruined this country’s healthcare system. They failed to come up with a viable public health policy and so Wall Street now drives the system. When financial interests override the interests of the patient, the healthcare system is doomed. We have to eliminate what we have now and start fresh.”
How can the system be fixed if you dismantle it? “It can’t be fixed,” he counters. “We can’t have a state-by-state system. The delivery of healthcare should be standardized across the country so that everyone has equal access to care. And by the way, it’s not a matter of a person’s right to medical care, it’s about the community. As a society and as human beings, we have to protect the community’s health because pathogens don’t discriminate between the insured and the uninsured.
“Those living in the large, more progressive, East and West Coast cities may not realize that HIV is still stigmatized in many parts of the country. Imagine what it’s like for a person in a rural community who is seeking HIV testing or treatment and the only doctor near you is your old family physician.
“New York and Los Angeles are magnets for doctors who seek the greater financial and professional opportunities they can offer. Consequently, many areas of the country have fewer doctors to serve the needs of the community.
“In Los Angeles, for example, where I treat many patients living with HIV, there are plenty of specialists and treatment facilities to choose from. While in other parts of the country, far fewer doctors per capita deliver care. This puts a lot of stress on regional healthcare systems.”
Skiba advocates for a system in which doctors are public employees. This, he argues, would stem the tide of doctors migrating to large metropolitan areas. Care centers established across the country would offer equal access to medical care, testing and education. The quality of services offered to patients would be as good in Kansas as it is in New York or California.
“Doctors would have the right to opt out of the public system and go private,” he points out, “but medical students would no longer have to face massive student debt just when they begin their medical careers. The cost of their education would be subsidized in exchange for public service.”
I ponder out loud why the American Medical Association, the uber-powerful Washington lobby, doesn’t use its clout to shake things up. Skiba shoots me the look one gets after asking a dumb question. “It’s the giant insurance and pharmaceutical companies that have the lawmakers in their back pockets,” he insists. “Legislators and businesspeople who don’t know a lick about healthcare are now making decisions about the delivery of medical care to patients.” He takes a beat then declares firmly, “That’s wrong!”
Since he’s already fired up, I raise another sensitive issue. Aren’t doctors a big part of the problem? After all, everybody complains that doctors charge too much. He flashes me that look again. “Nobody suffers through more than a decade of rigorous and costly medical training to get rich. If that’s all they want they go to Wall Street, not medical school.
“I earn less today than I did ten years ago, yet my expenses still go up. Doctors are the only professionals in this country whose reimbursements from insurance are defined by Congress. In effect, our incomes are set by Congress.”
I was intrigued by his statement. “A doctor,” he explains, “sends the patient’s bill to their insurance company, who reimburses the doctor for a fraction of the actual amount of the bill. If the patient has met their deductible, the doctor can’t ask the patient to make up the difference.
“In exchange for joining the carrier’s network of ‘participating providers,’ doctors must agree to accept the carrier’s predetermined rate of reimbursement,” says Skiba. “Patients depend on their doctor remaining in their carrier’s network, otherwise, they are forced to find another doctor who is ‘in network.’ The patient loses the doctor with whom they have built up a trusted relationship, and the doctor loses their patient. This is why doctors are giving up their practices or converting them into ‘boutique’ practices that don’t accept insurance reimbursement,” he explains. “Most of my patients who are living with HIV live pretty much from paycheck to paycheck because Los Angeles is such an expensive city. They could not afford the level of care they receive without health insurance.”
I still wasn’t clear about the role of Congress in determining a doctor’s income. “The percentage of the doctor’s bill that is actually reimbursed to the doctor,” he points out, “is tied to the percentage set by Congress for the reimbursement of doctors treating Medicare recipients. Insurance companies generally adopt this Congressional formula for all of their policyholders.”
After my talk with Skiba, I reviewed my own insurance statements. In April of this year, I had my annual check-up and lab work. The insurance statement indicated that my insurance company was billed $668.00. In turn, they reimbursed Skiba’s office $185.83, representing twenty-eight percent of the actual bill. Looks like I have a pretty good deal, right? Well, my insurance premium is $900 a month. Perhaps it’s time for the “leader of the free world” to catch up with the rest of the world.
“I don’t want to come across as a whiner and complainer,” Skiba offers. “America’s ability to provide patients with the most up-to-date care is unsurpassed. Our potential is limitless, but the system has broken down. Old ideas and assumptions no longer work. We need a new approach.
“Doctors have as much to gain as their patients from healthcare reform. Everyone must have equal and affordable access to medical care.” Heading off to his next patient, Dr. Skiba concludes, “There shouldn’t be a price tag for saving a life.”
Mark Rebernik is a contributing writer to A&U. He is a college instructor of law and an attorney based in Los Angeles.