By Chelsa Wagner
Allegheny County Controller
Last week, I announced HealthCarePGH.com, an initiative to draw attention to the real stakeholders of healthcare in the Pittsburgh region: the people. I believe it’s long overdue for elected leadership to step in and put an end to the terrorizing of residents by “healthcare” giants. What has transpired in the Pittsburgh region is reprehensible. Our residents—unlike those elsewhere in the state—are being treated as second-class citizens, deprived of the freedom of choice of healthcare provider. They continue to be held hostage by the very institutions their tax dollars built and continue to support. The solution must be unequivocal: restore full access for all our residents, regardless of which insurance card is in their wallet, and prevent all future attempts to restrict such access.
Every single person in this region is impacted, be it directly or indirectly, but the plain truth is that many of us are currently suffering the consequences. Even if it hasn’t impacted others yet, it is only a matter of time. On July 1, many seniors will lose their access to hospitals and doctors. In a few years, temporary agreements to continue access to Children’s Hospital and Western Psychiatric could also end. The patient consequences range from limitations on access to the most appropriate care, to excess costs incurred when the best care is utilized, to the inordinate stress caused by disruption and abandonment of longstanding patients.
These actions strip our residents of medical autonomy (autonomy, along with beneficence, non-malfeasance and justice being the four core principles of medical ethics).
It is well accepted that a patient must be his or her own health advocate and must play a key role in decisions of healthcare, particularly within the broken healthcare system that plagues our entire country. Yet, if you live in Western Pennsylvania, you cannot even be your own advocate, as you are being denied that basic right of medical autonomy, particularly as this divorce deepens and harms more and more of our residents. UPMC trumpets, “Choose your healthcare as if your life depends on it.” Choose? In reality, the choice of healthcare coverage that is affordable and ensures access to the doctors and hospitals that serve us best is reserved to the privileged few.
In spite of the fact that we are heralded as a region offering “world class healthcare” and a destination for individuals nationally and internationally seeking specialized care, few in our region have the freedom of choice. The latest round of propaganda for the UPMC For Life Medicare Advantage plan declares, “If you don’t have your health. You have nothing.” Well, congratulations, Pittsburgh: You have nothing, and UPMC hopes you won’t notice how much of your tax money they have. In fact, in their statement released in response to this latest effort to empower our residents, they responded:
“The wind-down of the UPMC-Highmark relationship has greatly benefitted Western Pennsylvania. Over the past five-plus years, the health insurance market has transformed from one the nation’s most highly concentrated and least competitive to one of the most competitive and pro-consumer markets in the nation. Businesses and consumers now enjoy insurance costs lower than anywhere else in Pennsylvania and access to UPMC’s world-class physicians and hospitals is easily attainable through a multitude of insurance plans widely available.”
Our residents were not born yesterday. The “wind-down” game they continue to play has not in fact “greatly benefited Western Pennsylvania.” And likewise, consumers are not enjoying lower costs, most certainly not without a diminution of coverage or choice.
UPMC in particular comports itself as the tyrannical aggressor in the classic abusive relationship. Its rhetoric lacks accountability, relying on its ability to compromise so many of our region’s institutions and politicians into silence. Many people think they need them—that they must be quiet or face retribution or loss.
Take for example how some twenty years ago, UPMC did business with one major law firm. Now, most of the full-service law firms in our region have some piece of UPMC business, so they and their employees must be silent or risk the loss of dollars.
Likewise, nearly every major charity (real ones) receives funding from UPMC, which regardless of their mission and good works compromises their ability to speak out. This is precisely why it is incumbent on the larger public to share our stories and demand an end to this abusive behavior.
These giants exist through being granted the privilege of doing business in this Commonwealth. As nonprofits, they should be held to even a higher standard. Yet it seems they have been effective in their reign of terror.
Because I am encouraging all of our residents to speak up and tell your stories to give meaning to how we are all affected, I want to take a moment to share how I and my family have already been harmed:
Days after my second son was born in 2012 (just one month after I was sworn into my first term as Allegheny County Controller), my left eye had swollen to the point where I couldn’t open it. I was diagnosed with “periorbital cellulitus,” resulting in a four-day hospital stay. Two months later, I suffered a reoccurrence requiring daily visits from a home-nurse over the Easter holiday. During the same period, my newborn was hospitalized for four days for an unknown virus, which appears to have been connected to mine. As I later learned, my primary care physician’s office had received the lab results during my first hospital stay, which indicated the virus was MRSA. However, they never followed up with me, so I did not know to take the necessary precautions to prevent further harm. Both I and my son fully recovered, but that experience was my main impetus to embark on a dogged effort to find the best healthcare providers and routines so that I and my family would never unnecessarily suffer something like that again.
Over the last several years, my husband and I have measurably improved our own health, collectively losing almost 100 pounds, being more active, and teaching our children better habits. We have been able to reverse many of the miscellaneous problems we have both encountered by prioritizing our health—from what we do and what we eat to identifying the network of care that best addressed our needs and concerns. But after we finally reached a point where we achieved real synergies to improve our health, we have been rocked by massive disruption. Though we found practitioners who were able to treat our whole persons and to whom we weren’t simply a number, but who understood our needs and objectives, we have been forced to play a game of Russian roulette, choosing which among them are going to stay a part of our healthcare and which are not; severing ties to providers we spent years finding and establishing relationships with.
For the past two years, we have tried different health plans and new doctors, experiencing the difficulty—and sometimes impossibility—of finding replacements for care we could no longer access. However, just last year, we finally gave in and changed our insurance to UPMC so that I would not lose access to some of the providers who have been integral to my own health journey: specifically, my general practitioner and midwives for well-woman care. This meant my husband lost his general practitioner so I could stay with mine. I lost my physical therapist, chiropractor, and dermatologist: all caregivers who have been integral to my wellness journey. Our relationships with these caregivers were personal. They were not commodities and not simply replaceable. As our own health advocates, we have spent time and money to establish a level of care, now only to have it ripped away in the name of profit and spite.
We can no longer go to the pharmacy that has filled our prescriptions for years, and instead often pay double – that is if we can even access them. We often learn that medicines ordered for us or our children are not covered, incurring significant out-of-pocket expense. In the most recent instance, we could not get a prescription for my son unless we “chose” to pay $550. This past year has cost us more than $3,500 extra out of pocket.
This collateral damage of the UPMC-Highmark battle—which UPMC calls “pro-consumer”—is contrary to any concept of “healthcare,” as the stress that it is causing families is antithetical to the very concept of health.
But here’s the worst part: relatively speaking, my family and I are in good health. Knock-on-wood, our problems do not hold a candle to the life-altering chronic or critical conditions many in our region face, conditions that are being exacerbated by this reign of terror. Some of the stories that I have heard and that have been shared on HealthCarePGH.com are truly unnerving and enraging. Collectively, the impacts on all of us, be they large or small, represent a massive impact on our residents’ health and financial security. Our residents are being denied dignity, justice and autonomy by institutions that we built and continue to fund.
Shedding light on the real human impact of this debacle is critical to compelling government action. On HealthCarePGH.com, residents can sign a petition directed to the Governor, Attorney General and State Legislature asking them to reverse the harm already done and to prevent further potentially irreparable harm, and circulate it among their networks (online or in print). They can also share their own stories of how this split is adversely affecting them and/or their loved ones (anonymously if desired).
Please join me in speaking out against the denial of choice and dignity that is being imposed upon our community.
Chelsa Wagner is a resident of North Point Breeze and is serving her second term as Allegheny County Controller.