Community Conversations

The Heartbeat of Homer

A position paper by Deland S. Anderson regarding a Community Conversation held at the Pratt Museum on 21 February 2003.

Twenty or so people convened at the Pratt Museum to discuss the topic of health care on the southern Peninsula. The perspectives represented were diverse—from the CEO of our community hospital to a local shaman. Sprinkled in between were practitioners of Chinese medicine, physicians, nurse midwives, emergency medical technicians, staff from our family planning clinic, and more. The mix made for a broad-ranging discussion. Some topics had a local focus, while others dealt with national or international health-related concerns. Certain issues emerged repeatedly in various contexts. There were also conspicuous silences on some concerns, especially those dealing with local matters. And while one cannot expect practitioners to divulge details of patients’ concerns, the community does have the need to understand the state of health care in the area, especially trends that will significantly impact local medicine whether for good or for ill. One wonders if silence on these matters was due to confidentiality or competition.

The principal topic that kept coming up was prohibitive health insurance costs. People complained that access to professional health care was becoming harder and harder to attain as costs of services and insurance costs spiral upward. A person remarked in this context that one didn’t dare get a job if one was on Medicare because the loss of health benefits could not be compensated for by out of pocket payments or through private health insurance.

Other recurring topics were the high cost of prescription drugs, universal availability of prompt and professional health care, and the need for education. This last item presented various facets. There is a clear need for community members to learn more about healthy lifestyles and to form healthy habits. This could only be achieved, one commented, if Homer could be presented as a destination for healthy living, somewhat akin to Switzerland, where being healthy is a matter of national pride. In this connection Homer’s alliance for a smoke free environment was endorsed as a positive development. Our annual health fair, sponsored by Rotary International and South Peninsula Hospital, is hugely effective in promoting healthy lifestyles and health education. Mention was also made of the need to educate people about the seriousness of type II diabetes and provide them with the knowledge of how to avoid developing this life-threatening and ever more common condition. The practice of selling sodas and other high carbohydrate snack foods in the schools was scrutinized. Along another vein, one participant attested to the need for greater communication between patient and practitioner—especially in this age of rapidly expanding health care information. Tremendous medical research facilities are available today at the touch of a fingertip through the internet. But so too are myriad advertisements for pharmaceuticals and other medical products and technologies. And, as one physician pointed out, not all patients have the medical background to distinguish between sound health care practices and worthless or even dangerous ones. Special note was made of the recent trend of patients coming to the doctor to ask for a drug they saw advertised on TV. This short circuits the process of diagnosis because the patient is already confident that he/she has the symptoms indicative of the advertised malady. Physicians, then, are leveraged to dispense prescriptions, possibly without warrant. Formal educational opportunities for aspiring health care practitioners are also needed in the region, as one participant noted. There is a chronic shortage of medical professionals allotted for one-on-one patient care. These nurses and technicians can and should be trained locally to fill local needs. Opportunities are increasingly more available through the local college, correspondence schools, and on the job training. One participant voiced the concern that people of the area need to learn more about the sheer variety of health care services available locally. The local availability of surgical and diagnostic services has improved greatly in recent times. Long term care, emergency services, and physical therapy are all better than before in the area. Talented new staff members have joined local clinics as family practice physicians. And a veritable cornucopia of alternative or non-Western medical options now exists in Homer. Homeopaths, massage therapists, chiropractors, counselors of all stripes, acupuncturists, eye doctors, dentists and hygienists and orthodontists, health clubs, hospices, old folks homes, assisted living and independent living centers, yoga classes, aroma therapists and more are all available locally. A final comment on this theme was that the local hospital could become an educational resource center and referral service for health care options in the region.

The economics of the health care industry was also a subject of considerable concern. Generally it was agreed that the field of medicine represents a significant economic engine for the southern Peninsula. And, much anecdotal evidence was presented to suggest that health related services comprise a growing segment of the local economy. This prompted some to wonder whether Homer is becoming a health care destination for Alaskans. Surely the recent arrival of many seniors to the area would not have occurred without a high quality medical infrastructure in place. But the relative boom in the local health care industry is not without its pitfalls. As one longtime resident physician remarked, fragmentation of core health services is becoming apparent. For example, labs and diagnostic clinics have been established in the community that siphon off revenue that is crucial to maintaining our community hospital. Maintaining a fiscally sound hospital in a remote region is especially challenging in today’s business climate. Revenue streams tied to government-funded programs such as Medicare and Medicaid are in jeopardy or are woefully inadequate in today’s economy. Insurance coverage has become more restrictive. Spiraling costs for pharmaceuticals and supplies and technologies further threaten the solvency of the hospital. These factors, moreover, are largely unchangeable on a local basis. So we need to turn to our leadership in Washington, D.C. for assistance. Numerous proposals regarding socialized medicine were made in this context. Universal high quality and prompt health care was a goal of all present. How to achieve this, however, remains difficult to envision. Recent innovations in medical procedures, technologies, and medicines have given great hope for those who suffer from debilitating conditions. But this hope comes at an astronomical cost. As one participant put it, a local health care cooperative would be wiped out by the cost of one kidney transplant. The need was expressed for people not only to take responsibility for their overall health, and not to lay that burden on society, but also for them to make responsible decisions about when not to elect for tremendously costly medical treatment. Though this was a sobering thought, consensus emerged that people need to know that they can and perhaps should say “no” to certain procedures under certain circumstances. People did not disagree when it was suggested that a shoulder replacement for a 93 year old was poor medical advice. But what about a hip replacement for an 80 year old, one wondered?