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Examining Healthcare: David Kuehn

David Kuehn is administrator for cardiovascular services west and northwest division, Marshfield Clinic, and an instructor in Lakeland College's healthcare management program. He has served in leadership roles in hospitals and the insurance industry for over 20 years.

David Kuehn takes exception when he hears the phrase healthcare "crisis."

"We in the U.S. are blessed with the finest acute care healthcare system known to man," Kuehn said. "We develop most of the new procedural things, life-saving equipment and drugs for the world. It's an expensive proposition. There's a crisis in financing the finest acute care healthcare system in the world."

Kuehn is concerned that politics are driving a quick-fix that might ultimately do more harm than good, and he's hopeful that discussions about real solutions will replace the politics.

"If we do want some other kind of healthcare, it has got to be something that is not defined as a political prize," Kuehn said. "You get the impression from the President and his party that the political prize is, 'No one else has been able to do this for you, so we are.' That's the problem with the debate - it's a quick fix, it's another program, instead of actually sitting down and saying, 'How are we going to fix this thing? We have issues coming in the future - are we dealing with those properly?'"

With the Baby Boomer generation slowly aging and needing more healthcare services, Kuehn said it will put a tremendous strain on Medicare, creating a whole series of new issues.

"Medicare and Medicaid drive reimbursement and drive decisions about new procedures and what is acceptable," he said. "It's a government-regulated and mostly-paid-for system. If you accept my premise, healthcare is not broken, the financing of it is."

Kuehn noted that the average lifespan in the U.S. has been climbing since the advent of Medicare in 1965, and the bulk of Medicare reimbursement is spent on the last years of a person's life.

"Medicare is probably one of the few programs you can walk into any facility in the U.S., flash a card and get services - no restrictions," Kuehn said. "That probably will have to be curtailed. It is going to hurt. Medicare could bankrupt us if we try to help all the Boomers who are quickly moving into retirement.

"The question is, do you perform a bypass on a 92-year-old woman? Can we do that for them in lieu of not covering young people? Medicare and Medicaid won't be able to withstand the sheer numbers of the Baby Boomers coming through the system. We have to take time to ponder how it's going to look."

Kuehn acknowledges that there is a major fiscal challenge of getting the uninsured access to healthcare, but he worries that those stories are being exploited for political purposes. In Wisconsin, Kuehn said, hospitals and clinics operate at a lower cost than other states, equipping Wisconsin with a variety of solid private, public and nonprofit healthcare systems.

"You can find some sad, very tragic stories, but I see those more as a political move to drive an agenda," Kuehn said. "We typically don't see that here - people not getting care. It's more of a political animal than an actual animal here in Wisconsin."

Kuehn said more people need to visit primary care doctors instead of sub-specialists so that chronic conditions can be identified and treated. He said the Medicare and Medicaid reimbursement systems pay specialists better than family practitioners, further compounding the problem.

"The system has a garage mechanic mentality," Kuehn said. "We love it when someone comes in and we take a piece out of them or put a piece into them and they walk out all fixed, instead of looking at long-term care."

Kuehn said he hopes any new system will reward quality healthcare operations that are controlling costs, and that find ways to ensure that people won't be facing bankruptcy if they need catastrophic healthcare.

"Everybody wants to save money on healthcare, but when everybody accesses healthcare, they want the latest machine. That makes it difficult to deal with. The issue here is the uninsured and the fiscal challenges of trying to get those people care and having them access healthcare where it's least expensive."

Kuehn noted research that says 75 percent of people in the U.S. are happy with their current health plan, so the potential for fallout is high if any new program proves unpopular.

Our physicians save lives every day," Kuehn said. "Twenty years ago, these procedures weren't available and people died of, in our case, heart attacks. It's incredible what doctors can do in a matter of minutes, how they can change the course of somebody's health.

"I don't think we want anything less, and that's my fear. If we try to do everything for everybody and be hasty about it, when Boomers get halfway through, we won't be able to tax people enough to be able to pay the Medicare tax."

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