By Lou Baldwin
Special to The CS&T

President Barack Obama has emphatically stated federal funding for abortion will not be part of any health care reform legislation. Dr. Chris O’Hara, president of the Philadelphia Guild of the Catholic Medical Association, doesn’t believe it.

“President Obama lifted the ban on funding for abortion in the District of Columbia and the ban on funding for international organizations that promote abortion. He may say this, but the current bills are silent on the issue; they do not specifically ban abortion,” he said.

O’Hara, who teaches pediatric medicine at St. Christopher’s Hospital for Children and Drexel University, and practices pediatric and adolescent medicine at St. Christopher’s, does not give referrals for abortion.

On the whole, he has a jaundiced view of too much government involvement in health care, especially a proposed “public option,” which would have a government-run plan along with private insurers.

“Not everything the government touches turns to gold,” he said. “Look at the Veterans Administration system.”

He recalls his own experience as a medical student spending time working in a VA hospital. “The place was abominable,” he said. “The doctors cared and I think the nurses did too, but the ratio of nurses to patients was really high. It was like the Third World.”

There are many reasons American medical care is so expensive, and O’Hara doesn’t think more federal money is the answer. He points to the parallel with higher education. The higher the government raises student aid the higher tuitions are raised. For the same reason, ever since 1968 when the government began subsidizing medical care through Medicare, costs have continued to rise.

Does overly-cautious, defensive medicine, prescribing treatments or consultations or medications that are probably unnecessary also add to the cost?

“Yes, absolutely,” O’Hara said.

Another major reason for high cost is unnecessary treatment at the patient’s requests. Patients might want tests or an MRI that the physician would not have suggested

“If it isn’t coming out of your pocket, it’s easy to ask for it,” O’Hara said. He cited a recent experience when a patient insisted on an appointment with a specialist, even though the symptoms didn’t warrant it.

In his practice he confides his opinion to the parents. If they are worried about a certain illness and it is extremely rare or the child is not the right age for it, he tells them so. “I try to minimize tests,” he said.

Sometimes patients request, or doctors will prescribe, newer medications that are enormously expensive but often no better than older ones, O’Hara said.

As health care costs rise, so do the ranks of the uninsured, which the U.S. Census Bureau set at 46.3 million last year. It will probably be higher this year because of the economic recession.

O’Hara cautions the figure is inflated by those who are not eligible for medical assistance, including undocumented immigrants, and also by millions more who may well be able to afford health insurance but choose not to purchase it, very often young working people who (sometimes mistakenly) don’t think they need it.

St. Christopher’s Hospital is in an area of the city with a high number of low-income people, and he does see incidents where, especially for the undocumented, it is difficult to obtain the care they need.

O’Hara cited an incident where the mother of a patient was being abused by her husband. She was undocumented and it was difficult to get her help. In another instance an undocumented patient was suicidal, but not eligible for Medicaid-funded treatment. In that instance, a mental health facility took her in as a charity case.

When that happens, O’Hara notes, the cost is really passed on to the paying patients, making their insurance premiums rise. Oddly enough, uninsured patients may actually get more care than the insured, he suggests, because the hospital is not under pressure from the insurance provider to release them.

Greater consumer responsibility could be encouraged through health care spending accounts, O’Hara suggested.

Typically such accounts are tax-free savings accounts, either employer or employee-funded. They are coupled with a cheaper, less inclusive medical plan. The consumer draws on the account to pay the deductible. Since the user is really paying this out of a savings account he or she is apt is look at the cost more closely.

“If they are paying for the drugs they will ask if there is a cheaper alternative,” O’Hara said.

Greater competition among insurers is also needed, he said. For example, the Philadelphia region is dominated by a single insurer, Independence Blue Cross. In this situation, O’Hara argues, the insurer has no real incentive to control cost.

“It’s no different than big screen TVs; at first they were expensive but competition has brought the price down,” he said.

In any case, O’Hara does not want a “government option” for medical insurance. “Government programs are putting your trust in princes and people, not in the Lord,” he said.

Lou Baldwin is a member of St. Leo Parish and a freelance writer.