Editorial: Losing a fender (Rutland Herald)

The decision by Rutland Regional Medical Center to eliminate a cardiac outpatient rehabilitation program is yet another sign of how the fenders are falling off the jalopy of our health care system.

Patients recovering from heart surgery had been able to take part in a three-hour exercise program twice a week at the hospital. But in September the hospital will end the program.

The hospital's supervised exercise program allows heart patients to exercise under the supervision of a nurse, which is important for their safety. Patients also have the emotional support of fellow patients in the group program. But the hospital was facing a serious budget problem, and officials decided the exercise program had to go.

The third phase of the program was a voluntary exercise regimen that was not covered by insurance. Patients paid $5 per visit for use of treadmills and exercise bicycles.

That meant the hospital had no source of revenue to cover the cost of the program. At the same time, the hospital was facing major cuts in Medicare and Medicaid reimbursements. Hospital administrators were estimating that hospitals in Vermont were facing a cut of $93.5 million in Medicare funding.

It is a perfect illustration of the way the health care system is falling prey to higher costs and narrowing access. Heart patients need exercise to recover from surgery and maintain their health to avoid a recurrence of heart problems. It is the kind of preventive care that is a cheaper alternative to surgery and other forms of expensive care that come in response to illness. And yet when money is tight, it is the preventive program that is cut.

Cuts in Medicare and Medicaid show the extent of the federal government's misplaced priorities (fill in here your list of worthy programs that could be funded with money presently being wasted in Iraq). Failure to provide a relatively small amount of money for preventive health care means that health care dollars will be devoted to costly procedures designed to respond to emergencies.

Meanwhile, Vermont's Catamount Health program continues to lag in enrolling uninsured Vermonters. State officials acknowledge the program will miss its 2010 target for making sure 96 percent of Vermonters will be covered by insurance. They say they are doing their best, that people are increasingly aware of Catamount, and that the 2010 target was an arbitrary one anyway

Catamount represents an effort to put the fender back on the jalopy. Yet with federal and state dollars running short, the effort faces a difficult challenge. Catamount is a good faith effort to widen coverage, but it is based on an insurance model with inherent flaws.

Critics of the Catamount approach say it is a patchwork repair. An alternative is what Sen. Edward Kennedy calls "Medicare for all." Skeptics would point to the failure of the federal government under the Bush administration to fund Medicare adequately, saying that under the government's aegis, it would run short of money, as it has for Rutland's cardiac program.

The answer, either under this system or a new one, is to demand that the federal government fulfill its obligations. Keeping people healthy is not a waste of government money. It is an example of its proper use.