I'll bargain with God, but not Jeffrey Romoff, for my life
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I wonder if UPMC President Jeffrey Romoff would like to come down from his penthouse and inhabit my world for the next few months. Maybe then he'd see the colossal folly of threatening to separate me and millions of others from affordable access to trusted medical providers when we're already holding on by our fingernails.
Next month, I'll be entering my fourth round of chemotherapy at UPMC in eight years. During that time I will be hooked up to IV lines pushing chemicals into my veins, the better to search out and destroy renegade cells that otherwise would proliferate unchecked.
The infusions will leave me feeling pretty nasty at two-week intervals. I will be weak and nauseated. My digestive system will go into revolt. Food will smell and taste disgusting. Steroids will turn my skin bright red and super-sensitive, and I'll despair of ever feeling normal again. Then it will pass, and I'll be more or less human for nine or 10 days until it's time to get knocked down again, and so on, until the tests show I'm in the clear. Or not.
I will do all this willingly because the alternative is unthinkable, and because I have complete faith in the medical team that has brought me this far in defiance of the odds. I trust they will do everything possible to keep me going, and that the result will be another reprieve.
Unfortunately, I have no trust in Mr. Romoff and his 24-member board of directors. They're too busy building an empire that will exclude my insurance provider, Highmark, to worry about upsetting patients.
The last thing I need in the midst of aching and retching and sleepless nights contemplating my own mortality is UPMC's president threatening to price me out of future access to the team that is keeping me alive.
That's where we're going if the standoff between UPMC and Highmark isn't resolved.
When their contract expires in mid-2012, UPMC says Highmarkers will have to pay unaffordable out-of-network fees for its doctors and hospitals or go elsewhere for their medical care. Unless, that is, they switch insurers, which is up to their employers, not them. Companies, meanwhile, want to choose policies that offer the best coverage at the lowest price. They don't need UPMC holding a gun to their heads.
We all know Highmark is no angel and that its nonprofit status is something of a joke. It's a serial rate-hiker sitting on a $4 billion surplus (which President Ken Melani says is needed to cover claims if the organization should somehow fail). It tried to jack up the rates on its lowest-income subscribers. Now it is pursuing an aggressive drug formulary that will save employers money on generics but put specialty medicines beyond most people's reach.
You'd think the region would welcome the prospect of breaking up that virtual monopoly, but UPMC's arrogance has made Highmark look like the good guy, or at least the less-bad guy. That's because Highmark is trying to buy West Penn Allegheny, a smaller, at-risk hospital system that is the only thing standing between UPMC and near-total hegemony.
UPMC says that makes Highmark a competitor, so all deals are off. When the current contract expires in June, consumers can do UPMC's bidding or suffer the consequences. That's a hell of a way for a tax-exempt charity to behave.
UPMC has many justifications for the breakup -- higher reimbursements, filling beds and, between the lines, obliterating its mortal enemy. Missing from the picture are the little people who pay that money, lie in those beds and have Highmark insurance.
Some of us are battling truly mortal enemies, in the form of disease. We don't need to hear the giants trading accusations. We need medical care from doctors we trust in the facilities our premiums and taxes helped build.
State lawmakers, prodded by angry constituents, have been trying to avert this man-made disaster. At a Senate hearing several weeks ago, Mr. Romoff made clear his priorities by channeling a five-year-old's raison d'etre: "All we want to do is to continue to do what we want to do."
Not pleased, the senators are moving ahead with bipartisan legislation that would allow the Pennsylvania insurance commissioner to extend the Highmark-UPMC contract by up to three years.
"We, as legislators, cannot simply stand on the sidelines and watch consumers get pushed off a cliff," said Sen. Don White, R-Indiana. Amen.
Almost nobody outside UPMC believes that West Penn will threaten its dominance. Just about everybody outside UPMC, and many inside it, believe this scorched-earth policy is wrong-headed, unnecessary, contrary to UPMC's mission and based on self-interest.
A reprieve from the Legislature would be all to the good, but a long-term solution requires more. Short of a single-payer system (let us bow our heads), we need tighter rules governing nonprofit charities and the teeth to enforce them. And since UPMC's board has gone underground, we also need a way to replace hospital directors who ignore the community they're sworn to serve.
After eight years, I've grown accustomed to bargaining with God on the terms of extending my lifespan. But I refuse to bargain with Jeffrey Romoff, who is not God even if he thinks otherwise.
The hospitals he runs were not created in six days by his hand from the void of nothingness, and they are not his to use however he likes. They were built over many years with the best of intentions and entrusted to UPMC as community assets, not as leverage for knocking out the competition.
From the beginning of this cancer journey, my goal has been to stay alive long enough to benefit from the next medical advancement. UPMC doctors and researchers have been in the forefront of that progress, earning Pittsburgh's good will and respect.
If Mr. Romoff and his board really believe UPMC's future depends on hoarding that expertise, they should resign and look for some other institution to undermine. Too many of us depend on this one for our very lives.
First Published December 18, 2011 12:00 am
