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

Have you noticed you can put "e-" in front of just about anything, and we all know what that means? We do so much online today – (r)e-tail, e-zines, e-trading and e-banking. And now there’s e-patient.

New research says that 61 percent of us go online for health information from trusted websites. We research symptoms to see if we need to a doctor, and then look up the diagnosis and treatment after we go to the doctor. About one in five e-patients interact with each other online, comparing experiences to broaden their understanding at Patients Like Me or e-patients.net

Whether it’s a simple diagnosis or a complex life-changing condition, being an e-patient helps us be effective and educated about what we can do to support our own health. I’ve talked in this blog about my own experience with looking online and replacing prescription meds with over-the-counter remedies – it was really empowering to do that myself because these options weren’t on my doctor’s radar.

People with the most experience in the health care system – those with chronic conditions – are really active e-patients, because they know how hard it is to figure out the treatment routine that works for them. They have a lot of experience challenging the system and asking “why” and “how much.”

As we are all paying more for health care these days, here’s another online resource for the e-patient: our Cost Generator, so we can be prepared with the real price tag of medical procedures.

If you've got an e-patient story, please let us hear about it at our Facebook page: www.facebook.com/TheRealCost.

— Susan with Regence

After House bill passed, more are asking: What's the real cost?

Real health care reform would put a halt to some of the $700 billion wasted each year in treatment and other expenses that do nothing to improve health.

The House bill does adopt new insurance rules and gets nearly everyone covered. But the consensus of news organizations around the country – and across the political spectrum – is that the bill passed by the U.S. House will do little to curb rampant medical spending.

Let’s not lose sight of real reforms that have the potential to reduce costs for everyone.

These people are also asking, "What's the real cost?"

Washington Post: Editorial: Flawed health reform
“As we have said, it does not do enough to control costs, and it is not funded in a sustainable way. Expanding coverage for the uninsured is imperative, but so, too, is getting the country on a credible fiscal path."

The Columbus Dispatch: Editorial: Cooking the Books
“Americans want an improvement in the nation's health-care system, not only for themselves but for their neighbors. But they should not be saddled with an unsustainable, unaffordable overhaul sold to them with accounting gimmicks and rosy projections.”

Huffington Post: Cost containment remains the missing piece
The most important debate - how to slow the inexorable growth of health care costs - has scarcely begun…. The House bill fails to deal seriously with the long-term challenge of reducing the unsustainable pace at which health care costs grow each year. That is what drives premiums up for working Americans, helps to price U.S. businesses out of global competition, and escalates spending on Medicare and Medicaid.

Philadelphia Inquirer: Historic but unaffordable
House plan … is unaffordable despite bearing the title "Affordable Health Care for America Act." Unfortunately, the House measure does little to rein in escalating health-care costs, and that, in the end, would harm the middle class and small businesses alike.

New York Times: How to control rising health costs
With the House’s passage of a health care bill and the Senate legislation possibly moving to the floor for debate next week, many analysts are saying that neither bill goes far enough to slow rising health care costs — an issue that President Obama has made central to his reform agenda.

San Diego Union-Tribune: Fear of health ‘reform’ is warranted
“Consider the…basic promises about…health overhaul: that it actually would save money, that the only new taxes would be on the very wealthy and that individuals would be free to keep their present coverage and doctors. Each of these claims is a myth.”

Denver Post: A long way to go on health reform

Los Angeles Times: Health care’s hurdles

Atlantic: The case for a cost containment commission

The Salt Lake Tribune: Health care reform

Weighing health care treatments: the big question to ask

But does it work?

Even if we don't say that question aloud, we implicitly ask it in our everyday lives. Each time we consider buying a new product or service, we want to be sure that it does what it says it will do. No one wants to throw away money.

But for some reason, when it comes to health care, people do seem willing to undergo treatments without asking: Does it work?

We assume doctors and medical experts are making decisions about our health care based on proven effectiveness. Strangely, that's not always the case. Treatments can be prescribed because they're new (not always better), or accepted (not always proven) even because of where a doctor was trained.

But decisions in health care need to be driven by a main criterion: data. One way to get data is comparative effectiveness research. The first advantage isn't too hard to figure out: Proven results would be better than guesswork.

Medical care is extremely complex: having some 13,000 diagnoses, 6,000 drugs and 4,000 procedures makes it difficult to pick the best course. Comparative research examines all the available medical studies and literature and delivers comparative data so doctors diagnose and treat illnesses based on evidence-based outcomes.

This is already happening on a piecemeal basis. Health care reform could make it more systematic. By combining the best research evidence with a patient's values, treatment would be more effective.

Along with more accurate diagnosis and care, there's a second advantage to evidence-based medicine: costs might just be lower. Why? Currently the health-care system pays for treatment whether it works or not. But just because it’s covered is no reason to waste your time with a treatment that isn’t effective.

When your doctor suggests a medication or other treatment, don’t be afraid to ask: But does it work? Don’t hesitate to do your own research on the Internet to get as much information as possible, and actively participate in decisions about your health.

The goal is for you to be comfortable that the tests or treatments recommended by your doctor are based on broad evidence from the medical literature. That's one way to begin to get health care costs under control — and to get good health care and lifestyle choices in your control. Where they belong.

New video demonstrates system inefficiencies. Has this happened to anyone else?

The other day I got home from work and sorted through the endless amounts of junk mail and bills that I receive day after day. One piece specifically caught my eye this time – what looked like billing from my OB/GYN’s office. When you’re closing in on nine months pregnant, any piece of mail from your OB’s office is of utmost concern.

I immediately ripped open the envelope and scanned the complicated document to read on the final line, “you owe $3,875.89.” I was floored! Yes, I realize I have had what seems like hundreds of ultrasounds due to minor pregnancy complications and monitoring, as well as additional prenatal care, but almost $4k out of my own pocket just didn’t sound right.

See, I work for an insurance company – not only am I self-covered by my work insurance, but I’m also covered by my husband’s. In fact, during my first prenatal appointment, I met with my OB’s billing department to find out exactly what I would need to pay out-of-pocket when this ordeal was over. As most everyone, we live on a budget too. I was quite impressed when they gave me a complete listing of how much each portion of the care costs, why it costs that much, and more. I was also told that because of my pleasant “double- insured” situation, that I would have to pay very little, if anything, out-of-pocket after delivery.

So why the sudden $4k?

The next morning I contacted my doctor’s office and was told to “ignore” the statement – that my situation was the same despite the additional testing I had undergone, and “not to worry about it.” Only problem is, if you read the fine print it also states that if I don’t pay the $4k by X date, I’ll be charged interest. However, after questioning the billing department again, and contacting both insurance companies, I’m still unclear as to what I’m really responsible for when this is over. But what can I do other than just wait for another bill in the mail?

Has this type of thing happened to anyone else out there? I’m sure it has. That’s why I got a kick out of this video called “Checkout.” Watch it, and let me know what you think. Here's a link to it on WhatsTheRealCost.org http://www.whatstherealcost.org/wtrc/toolbox/connect.html?video&site=.