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The American health care system is broken and headed for a wreck, retiring Community Medical Center chief Grant Winn said this week.

"Hospitals are near extremus," he said in an interview. 'Some of them are near hanging by a thread, especially the small hospitals.

"The biggest challenge will be how do we reform the health care system, improve the health care policy, in this country? In my opinion, there must be a drastic overhaul."

Winn, who began January with Community in his past, worked as a hospital administrator for 32 years, the past 27 as president and chief executive of Community. During his tenure, the medical center grew from a $50 million-a-year operation to a $150 million operation.

Winn began his career working in health care in the military from 1958 to '62 and then worked as a profusionist in a surgical research lab for cardiac surgery in Salt Lake City. Back then, health care was paid as fees for service, he said; doctors and hospitals wrote off people who could not pay. Costs were much lower.

In the 1960s, Medicare started paying, on a simple costs basis, for those older people who could not pay, as well as those who could. There was no cost containment. Costs rose higher and higher. The federal government started scaling back the rates it would pay. Medicine shifted those costs to the private payers and insurance.

"So there is cost shifting," Winn said. "We have a sick tax in this country. Every time we use hospitals and physicians, we pay a premium."

Those reimbursement shortfalls combined with astronomically high malpractice insurance rates have created a system ready to cave in, Winn said.

"Now, physicians and hospitals are often losing money on every patient," he said. "There is a misperception that physicians are wealthy. Their incomes are going steadily down."

Last year, Community wrote off $50 million of its $150 million in billed charges because of the shortfall and care it gave to people who could not pay.

"So now," Winn said, "hospitals are struggling to keep a 1 or 2 percent margin."

Winn advocates a fresh look at an overhaul of the system and hopes to be a part of a solution, perhaps as a lobbyist or consultant.

All aspects of health care need to be examined, he said, even those that are taboo.

For instance, 80 percent to 90 percent of the health care dollars spent on an individual throughout life are spent in the last three to six months of life, sometimes after the person has a terminal diagnosis. That's about $2 trillion a year. That care is not always the best decision, Winn said.

"I'm not talking about rationing, and I would never propose withholding any kind of health care," he said. "But I do think the question has to be asked, does this improve quality of life, does it significantly extend life, is it worth the cost?"

Winn also sees "enormous waste" in the system. For instance, any doctor can order CT and MRI scans that cost thousands of dollars, and most do when there is the slightest question, despite the odds. It's frightfully expensive. But it's not the fault of doctors.

"If anything is missed, guess who ends up in court?" Winn said. "The physicians have to do it to protect themselves."

The way health care bills get paid also drives providers toward expensive tests, he said.

"I can tell you there is a lot of service and care that's provided that does not benefit the patient," he said. "It benefits the physician, the surgeon, the hospital, the radiology equipment company.

"It's almost blasphemous for me to say it, because the hospitals need the volume. The margins are so small. So what they've done is raise their charges for a smaller and smaller percentage of the population."

There is not another health care system that we should take as a model, Winn said, not England's, not Sweden's, not Canada's. A solution for the United States will be much more complex, he said. But they should all be studied for ideas.

"If we don't change, we're headed for a wreck," he said. "We've been saying that for years, I know. It takes a long time. They've just been propping it up and propping it up and propping it up."

There are plenty of smart people with ideas about reforming the system, Winn said.

"I think there's a lot of energy out there around what do we do about this animal that's bankrupting us," he said.

"If we just focus on developing a rational health care system in this country, everybody could get the care they needed."

Reporter Ginny Merriam can be reached at 523-5251 or at

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