Time To Pay Up!

(This column was first published in the Laconia Daily Sun on June 3, 2009)

Two times over the past three years I’ve been admitted as an inpatient at Lakes Region General Hospital. The care I received during those stays was extraordinary, as was the subsequent outpatient care extended. The dedicated professionals, from the nurses and physicians, to the technicians, surgeons, pharmacy workers, and orderlies, as well as the administrative staff and the incredibly devoted volunteers, have earned my gratitude and esteem.

Like the thousands of others who have come to rely upon LRGH and its ancillary operations and practices, I realize just how fortunate we are to have this resource available in our community. Yet, its very survival is at risk due to inadequate funding, a perennial problem that is being exacerbated by the state’s fiscal crisis.

Over the past few years I’ve written extensively about the challenges facing LRGHealthcare, which serves an aging population, a marketplace where fewer employers are able to afford to provide health insurance coverage, and rising costs that simply are not being offset by increases in revenue. At issue is our willingness to pay for the costs of services being delivered.

Currently, our local health care providers are struggling to accommodate an alarming expansion in the number of patients dependent upon Medicaid and Medicare, the two primary government insurance programs designed to ensure that the poor and the elderly receive basic health care services. It’s alarming because neither Medicare nor Medicaid come close to reimbursing the hospital nor doctors for their costs of treating insured patients.

Instead, costs are shifted to private insurers and to those few who pay cash out of their own pockets. It’s that cost shifting that has helped fuel the rise in private insurance premiums.

Tragically, with the state facing a budget meltdown, the stage is set for Medicaid and Medicare reimbursement rates to be lowered even further. According to Henry Lipman, LRGHealthcare Vice President and Chief Financial Officer, the proposed cuts will trim over $3-million annually from the non-profit’s revenues.

Add to those losses the increased demand for charitable care as more and more people lose their jobs along with their health insurance, and it’s abundantly clear that LRGHealthcare and its providers are facing an economic tsunami.

State budget writers are taking the heat for the proposed cuts in state health care spending, accused of being irresponsible at best, and heartless at worst. But the fact remains that the legislature can only appropriate expenditures that can be covered by revenue, and New Hampshire is looking at what may be a $500-million shortfall in revenue over the next two years.

What I find so troubling about this is our tendency to blame lawmakers for the problem. It isn’t those we’ve elected to represent us who should be affixed with the blame. It is all of us.

As a state, we’ve come to expect something for nothing. We demand that government serve our needs, yet we balk when we’re presented with the bill. Admittedly, all of us cringe a bit when our PSNH bill arrives in the mail each month, and you can count me among those who deride the cable company for its predictable annual increases. Yet I’ve not once suggested that I shouldn’t pay the bill, realizing that the failure to do so would result in a prompt termination of services.

When government sends out its bill for the services it provides to its constituents, however, the complaints are deafening in their intensity, drowning out any reasonable discussion. People have come to embrace the notion that “government is bad”, forgetting that in a representative democracy, they are the government.

As much as we hate to admit it, our state and local governments run fairly efficient and cost effective operations in delivering the services demanded by the public. No, they’re not perfect. But then, I know few individuals who don’t waste a portion of their income, and government workers are individuals.

The fiscal problems facing New Hampshire have most assuredly been exacerbated by the overall economic decline. But there is undeniably a systemic problem that has plagued the Granite State for years that is rooted in the refusal by the state’s residents to pay for the services they demand. The New Hampshire way is to try to get others to pay the bill for them, whether it be local governments targeting Concord, the state targeting Washington, and everyone trying to entice folks from Massachusetts into paying our bills.

Grow up, and pay up New Hampshire. Otherwise, you’re going to find that government, just like PSNH and Metrocast, is going to terminate service. And that will likely mean that LRGHealthcare will be unable to respond with appropriate quality care when your life depends upon it.

(Ron Tunning is a former newspaper editor and is currently chair of the Laconia Democratic Committee.)