Letters to the Editor

Speaker Oliva’s healthcare ideas need historical perspective

Florida House Speaker José Oliva’s interest on healthcare is commendable. His proposal to expand the scopes of practice for nursing practitioners, broadening electronically, and outpatient facilities care delivery are great ideas. On the other hand, his trust on deregulation and increasing competition as the silver bullet to fight rising health care costs can seriously backfire.

Healthcare demands consumer empowerment, providers’ commitment to care, accountability and value outcome. We need to learn from history.

In my 26 years of experience leading the largest home healthcare agency in Miami-Dade, I’ve seen that the elimination of the Certificate of Need in the 1990s opened the door to hundreds of home care agencies and rampant fraud. It lowered the quality of quality as a means to make quick money.

Our healthcare system operates on an open and competitive market. While we can debate levels of regulatory oversight, we cannot deny the open-market dynamic is a big part of the challenges we face, including increasing concentration of insurers, institutional and direct care providers, uncontrolled costs, particularly of pharmaceutical products, and disappointing outcomes.

Improving the system cannot be achieved piecemeal; it requires a comprehensive triple-aim policy approach: Improved health, improved care and optimal cost.

Making cost the driving force is inadequate and risky. For example, reducing access to care under Medicaid may deliver short-term budget savings but jeopardizes people’s health, making it much more expensive to treat complications resulting from lack of timely intervention.

I hope Oliva will encourage discussion involving all the actors influencing the performance of our healthcare delivery system.

Jose R. Fox, Coral Gables

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