From the frying pan into the fire-Has the Christie Administration naively sacrificed the ambulatory

The ongoing war of attrition in the contentious New Jersey healthcare sector was again highlighted in an article entitled ‘ Hospital-costs measure was too complex’ by Republican Geraldine Cardinale and published in a small north Jersey rag called the Bergen Record on June 17th 2015. The opinion piece describes the attempts by a number of state democrats to enter a piece of legislation that would severely curtail the amount hospitals could charge patients with out of network benefits. The writer criticizes the failings of the bill which include allegations that it would be too expensive to administer and is weighted towards the insurance companies. Bill S-20 is yet another piece of insurance company sponsored legislation that certain legislators want to introduce, which makes one wonder if these politicians have a ‘special’ relationship with the likes of Horizon Blue Cross, an insurance organization that accounts for almost 60% of healthcare policies in New Jersey.

With the introduction of the Affordable Health Care Act, or as it is more commonly known Obamacare, the complexity of delivering healthcare in New Jersey, already the most over-regulated state in the US, became extraordinarily and unnecessarily expensive. The irony here, if it really needs illustrating, is the fact that the AHCA was intended to reduce the 18% of the GDP that healthcare currently occupies but will in fact result in an elevation due to excessive administration and an uncontrolled insurance industry.

New Jersey had an opportunity to develop a world-class outpatient surgical sector, but due to the pervasive political corruption catalyzed by the Christie administration and large political donations from the hospital corporations, suffocated it almost to the point of extinction. I published an article in 2013 describing how the model for outpatient spine surgery had been formulated in New Jersey, and that the practitioners involved in the innovation that permitted the safe and effective management of complex spinal conditions on a same day basis should both defend and advance the work they had performed. Unfortunately the lack of organization within the minimally invasive spine community was a symptom of the lack of leadership that US medicine has suffered from in the last two decades.

The arguments for surgical centers as the primary locations of surgical services are persuasive due to the facts upon which they are based and which include the lower cost, reduced rate of infection and less blood loss due principally to the utilization of minimally invasive technologies. To many outside observers the obvious question would be why the Christie administration failed to take advantage of such an opportunity and the only answer lies within the age-old trilogy of money, power and corruption. The temptation of easy funds for his political war chest was just too much for the ex US attorney general to handle and as soon as he possibly could he started signing every bill whose language was hostile to the surgical center sector. The hospitals had invested too much and simply out moneyed the surgical centers.

Had Christie taken a little more time to consider the consequences of his actions and used a bit more wisdom and little less greed, then he would have been able to predict that of course once the hospitals had the surgical centers out of the way, they could open up the flood gates on billing, which as the article describes, is exactly what happened. The insurance companies were just as culpable in the creation of the monster about which the writer narrates as they failed to understand the dynamics of what would occur if the surgical centers were neutered. The surprising aspect to this writer was the strategic naivety they all displayed and as someone once said the ‘chickens have come home to roost’ and they are definitely going to make sure they do everything to stay.

What is interesting due to its complete absence is the lack of objection from the New Jersey public who seem to have fallen into the most abused catchall phrase in this region which is ‘ well this is New Jersey’, which simply equates to their unbelievable acceptance of government corruption. Without getting sidelined again on the revolutionary history of the US, it is difficult to observe the people of a country that once stood for rebellion and change, do nothing. The advances in outpatient medical care continued in other parts of the world unfettered by political corruption and one of the countries that has firmly seized the opportunity is India, whose healthcare sector has become synonymous with innovation and scientific progress. Narendra Modi, the recently elected Prime Minister, has sponsored multiple programs supporting the development of world-class healthcare facilities, and it is to these centers that Americans are now travelling to purchase healthcare.

At one time in history the British ruled the world and had, at least in their opinion, the most admired healthcare system in the world, the National Health Service. Today, however, it is a tragic shadow of what it once supposedly was and the irony is that David Cameron and his crew are engaged in making multiple visits to India with their trade cap in hand. The US similarly was once the beacon to which all doctors and patients looked and, if they could afford it, actually came. Today, as was the case with the once Great Britain, that beacon has dimmed and Mr. Christie might just have to accept some of that historical responsibility.