As the fourth part in our health care series, Spectrum conducted a phone interview with Larry Mitchel, PhD, director of Government Relations for Adventist Health. Located in Roseville, California, Adventist Health states that, "[o]ur mission is to share God's love by providing physical, mental and spiritual healing." It operates 17 hospitals with more than 2,600 beds, approximately 17,500 employees, numerous clinics and outpatient facilities, 14 home care agencies and three joint-venture retirement centers with a fourth on the way. It has facilities in California, Hawaii, Oregon and Washington. Adventist Health states that "as a faith-based, non-profit organization, we are motivated by mission rather than stock dividends."
What does your job involve?
LM: My primary role is keeping our leaders informed on matters that relate to health policy. So personally, I don't do very much direct lobbying at all. I am not a registered lobbyist. My work is inward focused.
Does Adventist Health have a part-time lobbyist?
LM: Yes, we contract with a lobbying firm in Sacramento for advocacy in California. Most of our hospitals are here in California so our advocacy is California-focused. In addition to our contracted lobbyist, who has other clients, by the way, we rely on a lot on the California Hospital Association which has a major presence in Sacramento. They have quite a number of lobbyists. And we accept their positions on most things as ours. There are occasional issues around that, but by and large we support their positions and calls for grassroots support. Our president is on the board of trustees of CHA. In the other three states where we have hospitals, Oregon, Washington and Hawai'i, each of the states have their own state hospital association and we very much rely on them and our hospital presidents. As far as federal goes, again, we rely pretty heavily on the nationwide American Hospital Association for cues on positions. _____ Sidebar:
CHA Health Care Reform Recommendations for Congress
- Adopt a uniform, essential benefit package that is community-rated and universally available from all payers, with transparency of premiums for the essential benefit package.
- Support universal employer and individual participation.
- Create governmental support in varying degrees for all people through tax policies, subsidies and sponsorship.
_____ On the cover of Spectrum, sometime in the 80s, Roy Branson asked the question: What's a little church like ours doing in Big Health Care? Hospitals and budgets have only gotten bigger since then. These days, what does Seventh-day Adventism have to contribute to the national health care debate?
LM: I think that part of what we bring is buried in our mission statement. That is a remaining, lingering, surviving notion of treating people as one, not bifurcating their spiritual from their physical from their mental. Though it’s not unique to us in a way, I think that the emphasis that we place on it is unique. When we have asked the question, “What do you think of when you think of Adventist Health?” The answer we typically get back is “mission focused,” or “mission oriented.” That goes beyond the normal meaning of a business mission, I think. After all, mission just means purpose. I think that there is a plus that people not related to our organization see when they see Adventist Health. And I believe that that’s true with other Adventist health care organizations.
Why do you say "lingering?"
LM: Remember that health care in early Adventism was the right arm of the message. An awful lot of time and change has occurred since those days. Technology, the way we are reimbursed, the relationship of health care to the church, we could talk for hours about all that and yet, given all that, there is a strong sense of commitment to communities, commitment to people, commitment to the spiritual welfare of our patients, not just their physical health.
What is Adventist Health paying attention in the national health care conversation? What does Adventist Health think of an issue like the so-called public option?
LM: Across our organization, when we expend a dollar of cost to treat a Medicare patient, typically elderly, we receive back, from the federal government, an average of eighty-five cents. And that's on cost, this is not some inflated, phony price. This is cost. That means for every dollar of cost we expend, we are losing fifteen cents. That means that we have to find someone else whose willing to pay for their care and fifteen cents more or some fraction thereof. In California it is even worse. Medi-Cal pays us around seventy-one or seventy-two cents on the dollar for beneficiaries. It is not just a problem for us; it is a problem for hospitals all across the country.
Has that margin been changing? Has there been identifiable trend? Is is going up or down?
LM: I think four or five years ago that it was bouncing around. But I think that since then and maybe even longer, the trend has been going downward. But I don't have data in hand to confirm that. And I stress that we are not alone in that, every hospital in the country is facing that. So, from a moral perspective one might totally embrace a public plan that would bring rational health care to millions more Americans, but not from a purely business perspective.
Our organization, and CHA and AHA, as well as other health care people I've talked to around the country are really not supportive of the public plan because it is predicated on this underpayment by government programs. And it is one thing if you've got a number of commercial insurance contracts that are willing to pony up the difference and make the books balance. But what happens when you move millions of people out of those programs into this public plan? Unless it is funded correctly and properly, providers in general (hospitals, physicians, etc.) will simply go under.
If I understand you correctly, you're saying that we already pay the difference through private insurance. They are covering - is that what you're saying?
LM: Yes, and Adventist Health's margins are under two percent, which means that we are really strapped to get capital - large loans for building projects and so on. The only way that we've been able to do it is because our results have been predictable from year to year. Yes, our income is really low - that 2% profit is on a total of two billion dollars. So there is very little room for error. ____
Look for the second part of this interview coming soon. It will cover more on health care reform as well as Adventist top executive salaries.
Thanks to Larry Mitchel for sharing the Adventist Health perspective. And keep an eye out for his article coming in the next issue of Spectrum's journal.
This is a companion discussion topic for the original entry at http://spectrummagazine.org/node/1785