Prescriptions for an ailing system

By HANNAH HOFFMAN

Of the News-Register

In the midst of the national tussle over health care comes a book by a local author who has taken a broader approach to the problem than legislators and analysts typically do.

"50 Meds for a Sick Health System," written by Randy Stapilus of Carlton, recommends solutions to 50 of the problems America's health care system is facing. Among the problems he identifies, and proposes solutions for, are over- and under-treatment of patients, spiraling treatment and system costs and lack of good information on the patient end of things.

This is the seventh book Stapilus has authored during a 30-year career devoted to reporting, commentary and analysis on politics and public policy.

After studying journalism at the University of Idaho, and working on the school paper there, he joined the news staff of the Idaho Press Tribune in July 1976. He went on to serve as political editor and editorial page editor at the Idaho State Journal, political editor at The Idaho Statesman and managing editor at Boise's KCBI-TV, winning more than two-dozen professional awards for his work along the way.

He founded the Ridenbaugh Press in Boise in 1988. Now based in Carlton, the company publishes subscription public affairs digests for Oregon, Washington and Idaho, produces a nationally recognized water rights digest, handles contract editing and publishing work for a variety of clients and maintains an influential public policy blog at Ridenbaugh.com.

Over the years, he has authored "Paradox Politics," "Upstream," "Governing Idaho" (with James Weatherby), "Outlaw Tales of Idaho," "It Happened in Idaho" and "Camping Idaho." But this is his first book dealing with health care issues.

His goal was to tackle the systemic nature of the problems facing America's health care system. "It requires a broader approach than it usually gets," he said.

Stapilus began researching the 163-page book about two years ago. The project took on renewed energy after he had his own close encounter with the medical system in June 2008.

Just 52 and previously of good health, he suddenly collapsed with breathing difficulties. And he and his wife were uninsured - not uncommon for self-employed entrepreneurs, given the size of the premiums.

He was rushed to Willamette Valley Medical Center by ambulance and quickly diagnosed with a double pulmonary embolism. While the care he received was effective and skilled, he said, the costs were enormous.

The ambulance ride alone cost $1,100. He then spent six days in the hospital, a good chunk of it in intensive care, and ended with a tab that seemed little short of astronomical.

Because none of the care he received was optional, or available anywhere else locally, Stapilus summed up the situation he faced this way in his book: "Your money or your life."

The 50 recommendations he makes represent an effort to address that quandary, and the system that creates it, element by element.

Stapilus does not attribute the problem to doctors, nurses or other members of the medical community.

Doctors at Willamette Valley Medical Center are "very capable of doing what needs to be done," he said. And he said, "That's largely true through our system nationally."

The tremendous amount of raw skill within the medical community makes it even more frustrating that health care in America is so flawed overall, he said.

Among his varied recommendations are: Simplified forms (No. 6), Internationally standardized drug pricing (No. 24), Clearer language in health insurance policies (No. 28) and "Wellness benefits" (No. 43).

In general, Stapilus argues against health care outlays aimed largely at covering overhead for hospitals and insurance companies. He would like to see physicians working for a salary, saying it would cut the extent and cost of procedures if doctors got the same compensation no matter what they did or didn't do for a patient.

He also contends that consumers need to be better informed. Hospitals should have websites that outline the costs of procedures and services in simple, straightforward language, he said. Pharmaceutical advertising should be banned, insurance forms should be more understandable and patients should take a more active role in their own care, he said.

Stapilus scoured books, scholarly articles, newspaper and magazine pieces and online sources in identifying issues and developing solutions. He said he did no direct interviews with people in the field.

Ultimately, he said, the best solution to the health care problem is for everyone - doctors, insurance companies, politicians, taxpayers and patients - to realize they hold some responsibility.

To those who don't want to pay anything for public health care, he has this response: "You are already paying, via emergency rooms and other high-cost facilities." In the long run, your insurance premiums are often going toward other people's care, he said.

Although he does not explicitly call for a public option in the reform legislation now wending its way through Congress, Stapilus makes it clear he thinks America's health care issues are a public problem.

"Just as there's no one magic elixir," he wrote, "so we're all going to have to accept some of the tasks, carry some of the load."

Like earlier books, "50 Meds" is available through Amazon.com. Order may also be placed by calling the Ridenbaugh Press at 503-852-0010 or visiting www.ridenbaugh.com.