The nation’s health care system is broken, New Jersey’s former health commissioner said in Morristown on Wednesday.
But how to fix it is not so clear, according to a presentation that was meant to explain the Affordable Care Act, commonly known as Obamacare.
“The fact is, our health care system is broken. We all recognize that,” Dr. Poonam Alaigh told residents attending the town hall gathering, convened by Morristown Mayor Tim Dougherty.
Child mortality rates are higher in the United States than in many other advanced countries, services are fragmented, costly tests are needlessly repeated because doctors don’t talk to each other, and 45 million Americans have no health insurance, said Dr. Alaigh, an internist who served as state health commissioner from 2009-2011.
Now, as a consultant to Atlantic Health Systems, parent of Morristown Medical Center, she is involved with an Accountable Care Organization collecting data from about 1,400 doctors and 75,000 Medicare patients at four hospitals. The goal is designing more efficient and cost-effective care, she said.
“The top 5 percent of the sickest patients use 50 percent of health care resources,” Dr. Alaigh said. “This is the low-hanging fruit. It’s okay to spend money if, at the end of the day, patient are getting good quality and good outcomes.”
End-of-life care is particularly bad in New Jersey, she said, with too much emphasis on medical treatments and too little on quality-of-life and patient dignity. She also cited an example of a Medicare patient who had visited emergency rooms 10 times last year; the health care system needs to manage these cases better, she said.
She shared the microphone with Lisa Narcise of Brown & Brown, a small employer health insurance company from Florham Park.
Lisa walked the audience through the basic levels of health insurance and subsidies offered under Obamacare, and the penalties for individuals and companies that fail to purchase plans.
But she had difficulty fielding questions about dental coverage and vanishing PPO plans, among other items, because, she acknowledged, she has encountered the same problems logging into Healthcare.gov as the rest of the country.
People in the audience shared stories of frustration since the federal website rolled out on Oct. 1, the same day of the federal shutdown. One woman cited repeated failed attempts to access the site in the wee hours of the morning.
Another audience member voiced concerns about the privacy of data collected by Accountable Care Organizations like the one run by Atlantic Health.
Someone else said specialists for his rare, chronic disease are hard to find. His current doctor is out-of-network, covered at a reduced percentage by his Preferred Provider Organization (PPO) plan.
But Horizon Blue Cross is eliminating PPOs from its private plans, and it’s not offering them under Obamacare, either, said the man, stating worries about finding a specialist who will be covered.
Another man from an area company with just over 50 employees–classified as a large employer under the Affordable Care Act–said compliance with the law could cost the company “hundreds of thousands of dollars.”
The man, who asked that his name be withheld, said his company has provided health benefits for salaried employees but not part-timers for 70 years. To continue that practice would subject the company to about $46,000 in fines–an option being considered, the man said.
Another scenario, he said, would be firing some employees, to avoid being classified as a large company.
Noting all the unanswered questions, Mayor Dougherty promised a follow-up meeting soon.
“There are a lot of questions, and a lot of concerns. People don’t understand the [Affordable Care] Act, as I don’t. It’s very complicated. There are a lot of concerns about how this will work. There will be another public session. The business community should show up,” the Mayor said.