It's time to fix the health care system in southwestern Pennsylvania

And end the medical grudge match, says Dr. W. DAVID WATKINS

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Where are the voices adamantly opposed to federal or state control of health care? Are they not as worried that the three health care organizations in southwestern Pennsylvania are becoming a monopoly as they waste money, raise prices and premiums without restraint and generate unreasonable profits despite their nonprofit status?

For years the Pittsburgh region has had front row seats to a variant of professional wrestling known as "health care" -- a three-way main event involving Highmark Blue Cross Blue Shield, UPMC and West Penn Allegheny Health System (and their entourages).

I have been privileged to watch this act unfold for two decades through the lens of experience as an attending physician and professor at Harvard University, Duke University and the University of Pittsburgh and their affiliated health systems. My family and I also have been consumers of health care at all three institutions (and at West Penn Allegheny).

I have seen major increases in charges for medical care and major outlays for advertising and political influence designed to "win" control of the health care business here. While this contentious fight proceeds, the quality of care has worsened or stagnated despite growing premiums and profits. There are no winners, save for a few executives and administrators, their supporters and associated vendors.

A win of this nature is a loss for the people of southwestern Pennsylvania. The focus should shift away from a strategy of vanquishing rivals toward more constructive and complementary approaches to the region's health care challenges. In the sandbox, we call it "sharing."

If we can't establish fair competition among all health care payers and providers who wish to participate, then we might as well embrace a universal single-payer system and eliminate the middle men.

The analogy to professional wrestling is apt. Rather than display discipline, grace, sportsmanship, fair play and character, our troika of health care institutions appear to be win-at-all-costs, howling bullies who profit handsomely by choreographing an outrageous show.

Most Pittsburghers recognize that the nasty fights among Highmark, UPMC and West Penn are childish and self-serving -- even as expensive advertisements, PR campaigns and slogans attempt to persuade us that we should take comfort in having "chosen" a health system as though our lives depended on it. How many choices do we really have?

At the risk of being labeled a heretic, I would mention that there is ample evidence the United States does not provide the best overall health care in the world and that the people of this region do not receive the best overall health care in the United States.

This is not to say that we don't have extraordinary clinicians, professionals and facilities. This is to say that our health care professionals and employees cannot perform at their best when they are controlled by institutions that prioritize power and profit over the delivery of high-quality health care.

I personally know many physicians, nurses and other health professionals in the Pittsburgh area who are disheartened by their inability to do their best work in the present environment. I have seen this frustration expressed in various ways. I have seen depression, anger, cynicism, a sense of defeat and disenfranchisement. I have seen early retirements, career changes, departures for "better" -- and not necessarily higher-paying -- opportunities. I have seen decreased commitment to teaching, research and continued learning.

I also have seen world-class clinicians reject aggressive recruiting offers to relocate to Pittsburgh -- not because of the quality of our research or the clinical environment but solely because of the unfavorable administrative and management environment. It is a shame and disservice that such talent and commitment is lost or underutilized. And it is a contagious hazard.

We consumers should not passively accept the profligacy, one-upmanship and distracting feuding of our local insurers and health systems. If we are to continue a private insurance model of health care delivery, we should demand a dramatic shift away from back-biting in favor of meeting the moral and ethical obligation of providing the best health care possible at reasonable cost.

Progress should be defined in terms we all understand and support: quality, safety, compassion, efficiency, value and, yes -- dream a little -- even modesty and decorum. This is the path toward creating the best health care in the country and the world.

Unless we bring to an end this region's health care wrestling match -- either by the current threesome cleaning up their acts or by encouraging new challengers to participate -- we can expect more wasteful posturing, progressively less value for our insurance dollars and larger purses for the winners. The virtual monopoly we face now supports the case for government-controlled universal health care -- for better or worse.

Dr. W. David Watkins is a private consultant and professor emeritus of anesthesiology and critical care medicine at the University of Pittsburgh and Duke University (drdave@


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