A Bitter Pill 

Bredesen's purging of the rolls is the wrong Rx for TennCare.

From its inception, TennCare was a flawed program. Too many people outside of health care were involved in its design and had a financial stake in it. Still, TennCare became the health insurance program for 1.3 million citizens of Tennessee. And, predictably, it was not long before we realized that TennCare desperately needed to be fixed.

Governor Phil Bredesen's recently announced "remedy" leaves 320,000 people to fend for themselves in a very frightening health-care world. While most readers' eyes glaze over when they read the word "TennCare," everyone in the state will have a friend or a loved one or a co-worker who will be dramatically affected by what is about to take place. It will not strike quickly like a tsunami but will instead leave people to slowly suffer -- with few or no resources to turn to when they get sick.

There are other solutions to the financial crisis brought on by TennCare than the one Bredesen has proposed. Adjustments could be made. For example, TennCare currently provides patients with any medicine on the market, yet physicians can manage the majority of illnesses with only 30 drugs, most of which are sold as generics.

If we are to save TennCare, we must return to its original intention, and that is to manage care. Primary-care doctors should be paid an adequate fee to help keep people healthy enough to work and avoid disability. Instead, TennCare's provider fees are so low that few physicians agreed to even treat patients on TennCare.

To improve care, physicians must have the confidence to do the right thing. As long as physicians are afraid of being sued, they will continue to order unnecessary, expensive tests. Tort reform and cost control go hand-in-hand. In the meantime, young (sometimes inexperienced) physicians who treat many TennCare patients practice defensive medicine by admitting patients more often to hospitals and ordering more tests -- dramatically driving up the cost of care.

The solution to TennCare's woes requires shifting our focus to prevention and disease management. We would have to do more with less. High touch rather than high tech. And the legal system would need to be held in check.

On the other hand, Bredesen has inappropriately blamed the lawyers at the Tennessee Justice Center for providing obstacles that could not be overcome. In particular, he accuses center director Gordon Bonnyman of single-handedly bringing down the system. The Tennessee Justice Center has served the rights of poor people in Tennessee well, but its representatives cannot be blamed for the demise of TennCare. They simply do not have that much power.

William Sloane Coffin, the famed activist and chaplain, once said to me, by way of offering advice for the work of the Church Health Center: "Never let charity get in the way of justice." Soon tens of thousands of newly uninsured patients, many of whom already have serious diseases, will be knocking at our door, seeking help. I know now more keenly than ever what Coffin meant.

Why should people who work, pay their taxes, and care for their families be dependent on the charity of others when they get sick? In America, we offer ourselves as a model for the world of a just society. How can we spend $5 billion a month on a war halfway around the world when we are unwilling to care for the very people who are working to make our country strong?

I have criticized the structure of TennCare since its inception. It has always needed to be fixed. However, Bredesen's plan to allow 320,000 of our most vulnerable citizens to stand alone is morally wrong. n

The Reverend Dr. Scott Morris is the founder and executive director of the Church Health Center and the Hope & Healing Center of Memphis.

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