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Preventive Medicine 

Harrisburg moves to lance a boil

In these times of partisan gridlock, it's not easy to bring Democrats and Republicans together. But in trying to sever its ties with Highmark, the executives of UPMC have done just that. At least in Harrisburg, UPMC CEO Jeffrey Romoff seems to be curing paralysis so thoroughly that someone ought to try bottling his ego in a drip-tube.  

Since Highmark plans to acquire the West Penn Allegheny Health System, UPMC insists it will charge Highmark customers out-of-network rates next June, rather than risk subsidizing a competitor. That has caused widespread panic. And last week, the House passed a bill compelling UPMC and Highmark to settle their differences through mandatory arbitration. To borrow from a UPMC ad, if that bill becomes law, "the conversation continues," whether UPMC wants it to or not.

The measure passed 186-6. That's only six votes less than the margin enjoyed by HB 396, which earlier this year set stiffer prison sentences for pushers whose drugs kill their customers. Some types of "life-changing medicine," it seems, aren't very popular in Harrisburg these days. 

"We sent a strong message" with that vote, says Shaler Republican Randy Vulakovich, who sponsored the UPMC measure. 

Vulakovich acknowledges that "it was a struggle for me" to put aside the GOP's strong free-market principles. Then again, when has health care ever been a free market?  As Vulakovich notes: "Tax dollars have been used to build and add on to those hospitals. They don't just belong to UPMC." And they perform a public service, he adds. "I'm not saying Mr. Romoff is a bad businessman. I'm just suggesting he's lost sight of his organization's mission."

In some ways, UPMC is a victim of its own success: Its empire stretches from Pittsburgh to places like Bedford County, where it operates the sole hospital. By carrying its battle with Highmark into rural areas, it's generated bipartisan resentment: Republicans, too, are hearing the outcry. UPMC may now be mightier than its rival Highmark ... but in growing large enough to oppose the enemy, it has become the enemy of us all.

"The legislature is standing up and doing something relevant," says state Sen. Jim Ferlo, a Lawrenceville Democrat and longtime critic of both health-care behemoths. "In that sense, this is a victory."

Ferlo hopes support for the Vulakovich bill would lead toward more sweeping reform. Democrats have proposed a number of measures, including a bill to require health-care providers to bill all patients equally, no matter who insures them.  Insurers would have to compete on the basis of price and service, rather than on the ability to take doctors hostage. 

But while Gov. Tom Corbett has publicly stated a willingness to intervene in the dispute, he's stayed quiet. Vulakovich hasn't heard from Corbett on his bill, but says, "I know he's doing work behind the scenes to bring [UPMC and Highmark] to the table. I hope I have made it easier for that to succeed." 

But his bill may go too far for Republicans in the state Senate. The only legislation moving there is Senate Bill 1358, which allows the state's insurance commissioner to freeze existing contracts in place for up to three years. That bill, sponsored by Indiana County Republican Don White, was supported unanimously by the Senate's Insurance committee.

Really, a moratorium is the least Harrisburg can do ... which is why it'll probably be all that happens.

Such a measure "is probably as far as people want to go," says state Rep. Dan Frankel, the Squirrel Hill Democrat who co-sponsored Vulakovich's bill. But, he adds, "The stars are aligned for something to happen" -- and even a three-year delay "would be helpful."  

For one thing, President Obama's health-care reforms will have gone fully into effect by then. In 2014, for example, insurers will be barred from refusing customers with pre-existing conditions, a source of concern for many chronically ill Highmark subscribers worried about losing either their doctor or their plan. And Highmark will have had extra time to shore up the West Penn system, which has been struggling financially for years.

A moratorium isn't radical therapy, especially for growths as large as UPMC. But then the most basic rule of medicine is "First, do no harm." Nice to see someone still remembers it.

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