photo by: Mike Yoder

U.S. Sen. Jerry Moran, R-Kan., right, visits Lawrence Memorial Hospital on Wednesday, Jan. 2, 2019. Meeting with Moran, from left, are Tom Bell, president and CEO of the Kansas Hospital Association; LMH President and CEO Russ Johnson; and LMH hospitalist Marc Scarbrough.

LMH Health President and CEO Russ Johnson has made a career of watching the money in health care. As he gets set to retire this summer, he made an observation about money and medicine.

There’s probably too much money in the industry for it ever to change on its own.

Johnson, when chatting with me for an article earlier this week about his pending retirement, didn’t rule out playing a role of advocate for U.S. health care change once he retires at the end of August. His voice might have a different tenor than many in the industry.

“I am probably the minority in my field, but I would take Medicare for everybody, like that,” Johnson said, snapping his fingers. “The reason I would do that is because it would strip out so much expense and overhead in hospitals. Our largest department is our business office.

“If we knew everybody was going to pay us like Medicare does — it is timely, we know how much we are going to get, it is predictable and they don’t jack us around and do a bunch of denials and play a bunch of games — we could simplify health care enormously.”

As for when such a change could happen, well, you had better hope that waiting room has a comfy chair and a good selection of magazines.

“I think it would simplify it for customers and for families and for health care, but there is too much money in health care right now to go that route, I think,” Johnson said.

The idea receives pushback both from the hospital industry, with some leaders there worried about the lower rates Medicare pays for many services, and also from the health insurance industry. Medicare for all could be an existential change for the private health insurance industry, which has become dominated by about a half dozen companies that are now some of the largest corporations in America.

Certainly, there is no guarantee that Johnson’s theory is correct. Multiple studies have found that private insurance companies pay hospitals 150% to 250% more for many services, compared to what the hospitals receive from Medicare for the same service. Medicare for all, thus, would mean that hospitals would have to strip out a lot of expense to be on the positive side of the equation. If the cost-cutting doesn’t materialize, the impacts could be dire.

But, of course, there are dire situations in health care today, too. They often show up when the free market nature of the health care system bumps against human nature. For any free market to work, you have to be willing to walk away from a deal. But there are times in health care — think of a loved one needing care to save their life — where no price for a procedure is so high that you voluntarily would walk away from the deal.

The result is that we have a health care system that kind of works as a free market system, but kind of doesn’t.

“If we really had a free market solution, what we essentially would be saying is that millions of people will go without care, and that is OK,” Johnson said. “I don’t think that is what this country wants to say, but it hasn’t, in my mind, found a real rational model to address this.”

Johnson said there would still be plenty of room in health care for free market competition for services, but it shouldn’t be at the “basic foundation” of health care.

“If you have got the money and you want to do something that involves care beyond the basic foundation, you could do that, but everybody ought to be able to walk in and get a primary care doctor,” Johnson said.

But let’s be honest. It is not clear that the American public thinks a government-run program will make the system better. Trust in government is hitting new lows, and roughly half the country seems interested in making government dramatically smaller. On the other hand, cutting Medicare also seems to be a political nonstarter, which presumably is a sign of its popularity with those who have it.

Regardless of your analysis on that point, Johnson doesn’t think change is likely to come from a groundswell led by ordinary health care consumers. The current system makes it hard to even think through the issue.

“Health care is so confusing,” Johnson said. “Let’s face it, most of us who are not in the health care field don’t even think about how it works. . . Most people just don’t think about it, and I think that allows us to keep on keeping on in a way that is not in everyone’s best interests.”

Johnson, who said he’s been thinking about the issue a lot recently, believes there may be one group that ultimately will push for the change and might have the power to see it through: the general business community.

“I think health care won’t change itself from inside,” Johnson said. “There are too many strong interests to keep it the way it is. I think the impetus for change will be when the business community says, ‘wait a minute, how come I’m competing in an international economy and I have to be responsible for the health care of my workers when no one else around the world is?'”

“We are really the only delivery system that has insurance based on where you work, on your employer. I think at some point business is going to find that and question that and say why are we doing it this way?”

Predicting when that could happen, though, is tricky. It probably won’t happen during the best of times, Johnson said.

“Business gets close to that when the economy turns down, but if the economy is good, they have other fish to fry and they don’t think about it,” Johnson said. “But I think they are the only ones who will change it.”

For now, though, the topic may be more about aspirations than action. I ended my interview with Johnson asking him about his aspirations both for the local health care system and the national one.

Locally, he said he hopes the hospital and its “physician leadership” continue to share a vision that they are part of a unique partnership with a mutual interest of taking care of the community.

The national aspiration shares a similar theme.

“My hope for the country is that we rebalance and reprioritize the portion of health care that is a right and not a privilege,” Johnson said.

Johnson said he thinks that will take an examination of the business arena of the health care industry.

“Health care is such a big industry and there is so much money in it, that it has really become a competitive business,” Johnson said. “There are some good aspects to that, but nobody competes for the person who can’t pay for care. Nobody competes for the services that aren’t financially profitable. That just leaves a subset of this industry, the hospitals, trying to eek that out.”

“I think there is a better way to do it.”