Andy Turner wants the government out of health care

New Mexico Business Journal, April, 1996

Probably nothing better symbolizes Turner's vision and the success of his corporation than the Sun Healthcare corporate headquarters, visible from I-25 North in Albuquerque. The strikingly modern building prominently features a number of sculptures and other art works, an aesthetic reflection of his commitment to the Southwest, and is crowned by an oval running track. Indeed this is not just first-class office space; it is a work of art in itself. Two more buildings were recently added to the complex, including the 12,000 square foot Glaesner Training Center, which features state-of-the-art communications and teleconferencing facilities to enable Sun Healthcare to train and communicate with its employees worldwide.

Turner, 49, received his B.A. from Ohio State University. He and his wife Nora have three daughters, Angela, 13, Meredith, 11, and Stephanie, 8. Ralph Odenwald spoke with him at his office.

NMBJ: You have been in the business of delivering health care services for more than 20 years now. How has the industry changed in that time?

Turner: Most of the changes relate to expense. The U.S. has a very good health care system - the best in the world - but it is very expensive. Most costs are paid on a cost-plus basis, and as a result there has been very little incentive to control costs. By the 1980s, costs had grown so much that we had to put the brakes on by reducing expense without compromising quality.

Payments had been primarily from private insurance or government, which didn't reward efficiency. They paid on a "cost plus" basis, and the result was redundancy and fat in the system.

NMBJ: As you point out, the government has played an increasingly large role in providing health care to the citizens of this country. What do you see as the proper role for government in this system?

Turner: The government should butt out. If that happened, market forces would quickly resolve the problems in the industry. The government has an obligation to support poor people, but it should fund them through the private sector.

NMBJ: How would that work?

Turner: Right now, the government either delivers services directly or purchases them through an intermediary. They should provide medical services to the truly needy, but they should hire a private company to do it. The government would hire a private company say, Blue Cross, for example - and tell them what services they are to provide to people and ask them to set guidelines and regulations for delivering those services. The government regulators are out of control. There are too many of them and they contribute directly to the cost of providing health services.

NMBJ: Are you advocating the elimination of Medicare altogether?

Turner: There shouldn't be a Medicare program as written today. Why should the government pay medical bills for someone like me who is relatively well off just because I reach the age of 65? The VA is a disaster. The cost per patient per day is the highest in the world, and if you ask someone who just got out of a VA hospital what they thought of the care, they would tell you it was awful.

We have an obligation to provide health care for poor people, but it should be managed health care under rules provided by the private sector. We should limit the government's role to the needy only. There is no sense for the government to pay a well-off person's medical bills, but in the case of Medicare, that's just what we are doing. It was improperly designed from its inception as a cost-plus program. There should be eligibility criteria based on income.

NMBJ: Is it politically realistic to expect such a radical modification of Medicare? The voters appear to feel very strongly about this program.

Turner: Not in our lifetimes. People have come to think of it as an entitlement. They feel like they have paid for this with their taxes for years and others have received it before them, so they should be entitled to receive it when they reach 65, too. We are taking small steps toward this now, but we will never get rid of the regulators completely.

NMBJ: Do we really want to get rid of regulators? Won't the quality of health care suffer?

Turner: The quality of health care suffers because of governmental support and regulation. The system takes away incentives to improve. The marketplace would close poor operators. If the government were to withdraw, disparities in quality would show. People would shop. They would find out which hospitals really offered the best care, and the ones that didn't would be out of business. We don't think about free enterprise in the health care industry.

NMBJ: Many people find it difficult or even somehow wrong to talk about providing health services as a business. Are the two concepts in any way incompatible?

Turner: They are incompatible only if we say that free health care is a right and should be administered by the government. Right now in this city you have hospitals that are governmental, not-for-profit and for-profit. All deliver the services that most patients are likely to need. So the compatibility now exists. Not-for-profits do make a profit, of course. They can't afford to run in the red any more than for-profits can. I think operating health care as a business is a must. As long as the government operates the system, there will be no incentive to do better.