For health care reform, the only way to keep costs low

Have you noticed in the health care debate how some people start talking about car insurance? Specifically the argument goes that all drivers are required to purchase car insurance, so why not mandate health insurance the same way and make everyone buy it?

The comparison is a little shaky, but interesting. As a driver it's reassuring for me to know that other people on the road are insured in case one of them hits me. I won't have to shoulder the price of someone else's mistake. With health care, the "shared responsibility" works a little different, but it comes down to this: Insurance costs can't be controlled without everyone required to buy in.

Here’s another example to help put it into perspective that the Wall Street Journal recently used:

Imagine that parking tickets were only 25 cents. Would drivers have much reason to feed parking meters? The answer, of course, is no. Paying a fine would be cheaper than putting a dollar or more into a meter. A weak coverage mandate would have the same result.

Think about it. If insurers cannot turn away anyone, and yet people are allowed decide not to buy insurance, what would happen? Unhealthy or sick individuals would purchase coverage, while younger, healthier individuals would conclude that they could save money by skipping it. As a result, the overall group of people insured would be less healthy, and thus the costs to each of them would increase.

What would happen next? Responsible people who are currently healthy would be hit with paying a lot more money. Without a doubt, some of them will decide that coverage is too expensive and will drop out. Which increases costs again, as the group loses even more of its healthier — and thus less expensive — participants.

By keeping healthy people in the insurance mix, the individual mandate will help keep average premium costs low. Pure and simple.

The Washington Post's Ezra Klein has a great blog post about the need for an individual mandate. It's worth the read.

Tell us what you think at our Facebook page.

— Susan with Regence

The first word in health care reform is health

There’s a lot of passion in the health reform debate about who should do what. Health plans should take everybody. Premiums should be affordable. The system should be more efficient. I say, "Yes" to all of the above.

But there are some things doctors, hospitals, medicines and health plans just can’t do.

Case in point: My husband Mike was diagnosed as “pre-diabetic” – not to worry, there’s medication for that. I said, “Whoa. Type II diabetes is wakeup call. We gotta make some changes.” What’s the big deal, he says -- one more pill, just a $20 co-pay.

I dared him to ask the doctor, “What would it take to lower blood sugar and not be pre-diabetic?” Answer: lose weight, start exercising. And that would also reduce your high blood pressure. Ha -- two birds, one stone, no meds.

Mike also got the low-down from friends with advanced Type II diabetes. Linda has such bad pain in her legs, “I wish they would just cut them off, some days.” Renee warned: “You do not want this. Stop it now.”

So, we got a stationary bike, adjusted our eating and he dropped 40 pounds in three months. The doctor was impressed: lower blood pressure and blood sugar. No meds—for now. The challenge is to keep it up.

Of course, a pill would be easier -- at first. Those (many) times we just want to watch TV and break out the snack food, it is reeeealy haaaard to remember -- walk, or suffer pain like Linda. Shut the refrigerator, or struggle with yo-yo blood sugar craziness, like Renee.

I realize not every disease is within our control, but these conditions -- high blood pressure and diabetes – usually reflect a lifetime of choices around food and exercise. They are strongly correlated to heart disease, which kills more Americans than all cancers combined.

No doctor can make me do the right thing. Having health coverage does not liberate me from the responsibility to eat right and break a sweat a couple times a week.

An act of Congress can get more people covered but it doesn’t come free. And, I still have to do my own exercise. Darn it.

What are your challenges to staying healthy? Please share what’s helped you stay on track at the What’sTheRealCost Facebook page. .

Susan at Regence

Concerns around cost of reform

Here’s what I want to know: how will health reform being considered by Congress affect what I pay for health insurance?

The Senate bill is estimated to cost around $900 billion; the House bill around $1.2 TRILLION (gulp). That money has to come from somewhere and I can’t shake the feeling that I’m going to feel it one way or another.

A much anticipated budget analysis from the Congressional Budget Office (CBO) released this week attempts to address those concerns. Unfortunately, it does little to clarify the matter, for a regular person like me anyway.

Here’s why: on the one hand, the analysis suggests that the large number of Americans who currently have employer-sponsored medical insurance – like me – would not see much change in their premium costs.

But get this: the New York Times Prescriptions blog says that “calculating the proposed legislation’s effect on premiums is so complicated that the budget office pegged its analysis to a single year, 2016.”

A single year?! How does an estimate for a single year inspire confidence that reform won’t cost me, or the country, a heckuva lot of money?

Here’s another head scratcher: those who buy health insurance on their own would see an increase, but about half would have that increase offset with government subsidies. Subsidies that would artificially lower premiums.

Many in Congress would like me to believe that health insurers are to blame for rising premiums. The hard truth is that premiums go up because medical care is expensive and we use a lot of it. And what happens to premiums is dependent on whether reform can lower health care spending.
Please understand, I support health care reform but I’m concerned that all we’re doing is expanding access to a dysfunctional system. There’s still time though. I’ve been hammering on my elected representatives to give me better answers.

I don’t want a fairy tale, I want accountability because we all deserve a health care system that works for everyone.

–Laura at Regence