In the ’80’s and 90’s, when HMOs first became widespread, we all experienced lower costs but less choice- we had to choose from a list of doctors and hospitals, i.e. “in-network providers”. But costs did stop rising, and in some cases actually fell.
Then came the managed care backlash and insurers allowed a much broader choice of doctors and hospitals.
Health care costs have nearly tripled since 1990 and now, the federal budget and nearly every state budget is threatened by extremely high health care costs. Of the many methods being used to try to contain costs, limiting consumer choice of providers is once again a common approach.
The way this works in practice is that health plans offer one set of prices for using “in-network providers”. If we use “out-of-network” providers, the amount we have to pay out of our own pockets is higher. Sometimes much higher.
Here is the question: How do you feel about having a limited choice of doctors and hospitals in return for lower costs?
As health care costs threaten more and more of our economy, various methods of addressing the challenge have been proposed, the Ryan plan for Medicare being one of the best known. In this plan, the Medicare system is revised to provide seniors with a fixed voucher to cover insurance premiums purchased through the private sector. When the voucher is used up, patients will have to pay out of personal funds.
Clearly, the well-off will be able to afford more care after the voucher is gone. Is this right?
This blogger believes that the quality of some things should vary with wealth:
- the well-off should drive nicer cars
- the well-off should wear nicer clothes
- the well-off should eat at fancier restaurants
But some things should not vary with wealth:
- fire protection
- water quality
- food safety
So here is the question- should the amount and quality of health care a person receives vary with wealth? What do you think?
What should we do about providing health care for people in this country illegally?
On the one hand, persons here illegally may put a strain on the system (I say “may” because ironically, many illegals do pay taxes).
On the other hand, to ignore the health needs of a large group of people has public health implications- diseases may spread within that population and then affect “the rest of us”:
- flu and related conditions
Also, for the purposes of this question, please assume that “sending all illegals back home” would take years, so we still have to deal with the issue, at least temporarily.
So here is the question- please select only one answer:
There are many clinical professionals in the health care industry other than physicians, including:
- Respiratory therapists
- Physical therapists
The laws are generally clear on what these other professionals are allowed to do and what they cannot do.
- Who can prescribe drugs
- Who can perform specific procedures
However, in the broad discussion about health care costs, the issue of what various professionals can do becomes relevant:
- A shortage of physicians affects access and waiting times.
- The supply/ demand balance affects the cost of services- if there aren’t enough physicians, thay can raise their prices and there is no alternative.
- Physicians threaten to refuse Medicare patients if rates are cut, and even Medicare has no alternative.
So here is the question:
Should non-physicians be allowed to do more in the direct care of patients? What do you think? Please select one answer.
Part 1- the problem.
If you look at our present level of health care spending ($2.6 Trillion), and project it forward, growing at 6% annually for the next 20 years, the total exceeds $100 Trillion.
That’s 14 Zeroes:
- Just for health care
- Just in America
- Just for the next 20 years (if we look at 30 years, the number is over $200 Trillion).
That number is incomprehensible. Not only is it not sustainable, it is not even possible to finance this number. Yet, that is the path that we are on.
The present discussion aims to “bend the cost curve” and to somehow shift the burden:
- Blame the insurers
- Blame the pharmaceutical companies
- Reduce provider reimbursement
- Limit what Medicare pays on behalf of seniors.
Whomever we choose to blame, we are clearly headed for a scenario where we all work our entire lives just to pay for health care, and when we get old, all of our assets, if there are any left, get paid over to our huge, for-profit health system.
We must fundamentally restructure our health care system, and our expectations of living and of dying, or life will become one long health-care payment treadmill.
Part 2- the discussion. Please answer the following questions. One answer per question:
Now, please consider all of the answers you provided.
What do your answers, taken together, mean for the 14 zeroes in our future? Something to think about…
All over the country, people, companies and entire sectors of the economy are experiencing, or will soon experience, drastic cuts.
- benefits of unionized employees significantly reduced
- salary freezes and reductions
- reductions in state provided services
Yet, in the health care industry, we talk about “bending the cost curve”, which means a reduction in the rate if increase, say, from 6% annual growth to 4% annual growth.
Why is health care exempt from the drastic cuts being made almost everywhere else? (In fact, it is health care costs more than anything else that is forcing states to the brink of bankruptcy).
So is bending the cost curve enough? What do you think?
This is a tough one…
On the one hand, physicians have to run their practices, which costs money. They want to live well, as we all do, and that costs money.
On the other hand, they provide a vital service which not just anyone is allowed to provide- so in a way, they are on “protected turf”- protected through licensing and long years of training.
But when physicians refuse to see Medicare or Medicaid patients, those patients have nowhere else to turn. In fact, the threat of physicians refusing Medicare is often used as a reason not to cut Medicare rates.
This sets up a sort of “health care hostage situation”, where we, as a society, can no longer afford the costs of care, but seem to be powerless to do much about it.
So here is the question. Actually 2 this time. What do you think?
When we visit a doctor, hospital or pharmacy, lots of data is generated:
- Lab tests
- Prescription information
- Physician notes
That information is exchanged among physicians, hospitals, pharmacists and insurers, all to assist in the care of the patient and to support the billing and payment system.
Yet, there is potential to mis-use this information:
- Data mining to target potential customers
- Data used for coverage decisions
- Data used for research purposes
And further, when a patient moves or simply wants to maintain their own files or health record, they frequently encounter resistance from the doctor or hospital when requesting copies of their record or tests:
- outright refusal
- “The HIPAA law won’t let me give it to you”
So who owns patient data?
What do you think?
Some have said it is the profit motive that is at the core of our health system’s problems:
- Insurers need to provide profits to their shareholders
- Hospitals and hospital systems need to provide profits to their shareholders
- Physicians perform tests with their own economic interests in mind
- Pharmaceutical companies and device manufacturers charge too much
A system that is not designed for profit might look as follows:
- A single payer health system
- All hospitals should be not-for-profit
- All physicians should be employees, and their employers should be not-for profit
- Pharmaceuticals, devices and supplies should be subject to price regulation
What do you think? Please select only one response.
As we all know, the federal government and nearly every state is facing huge budget gaps. Health care is a large part of every crisis:
- Medicare is a large part of the federal budget crisis
- Medicaid is a large part of every state budget crisis
Health insurers are not to blame this time:
- The Medicare discussion is about Medicare, not Blue Cross, Aetna, Cigna, United or Humana.
- The Medicaid discussion is about Medicaid, not Blue Cross, Aetna, etc.
The health care reform bill that we recently passed was really health insurance reform- yes, we needed to reform the insurance system.
Since Medicare and Medicaid are not traditional insurers, but still seem to be drowning in costs, the question is, “Where should we focus our reform efforts going forward?” What do you think?
It is becoming more and more important for each of us to take charge of our own health care and not depend on the “system” to do everything for us. The costs of care are slowly being shifted towards the individual. Consider:
Trends in private insurance:
- increased premiums, copayments, coinsurance and deductibles
- insurers can no longer deny coverage for pre-existing conditions (a good thing), but this coverage is becoming much more expensive
Trends in Medicare:
- increasing age of eligibility (proposed)
- increasing premiums for part B coverage
- increasing annual deductibles and copayments
- limitations on government responsibility (proposed voucher system)
Trends in Medicaid:
- reduced eligibility
- increased copayments
- fewer physicians will accept it
- shifting patients into managed care programs
What all of this means is:
- health care will become more expensive for the individual
- access to the system will become more difficult
To protect ourselves, our health and our finances, we must each become more self sufficient and take charge of our own health.
Here are some things that we, as individuals can do:
- Adopt healthier habits (diet, exercise, stress avoidance or stress management)
- Do your own research and have your own opinions about what is best for you
- Request (and receive) copies of your test results and exams
- Use a Personal Health Record (PHR), and keep copies of your test results in this PHR
- Ask your doctor educated questions about your plan of care. If you don’t understand something, discuss it
- Ask about the safety of drugs and medical devices
- Join disease or care-focused groups. Network, and ask people with similar conditions about what has worked for them.
- Research the cost and reputation of the doctors and hospitals who will be treating you
Most important, stand up for yourself. After all, it is your health, your life, and increasingly, your money.
We are headed for difficult times in this country.
Over the past 50-60 years, the economic pie has been growing. This has made possible a number of positive social changes, such as Medicare, Social Security, Civil Rights and Women’s Rights. When our situation is getting better, it is easy to share a little with those who have less.
We are now entering a period where the economic pie is shrinking, or at least perceived to be shrinking. What we now see is an unwillingness to share- in fact, many want to reduce or eliminate some of the social programs that have been introduced over the past half century.
I am not arguing that this is either good or bad. I am asking “how do we get there?” How do we reduce the costs of health care in a way that is fair? Who pays? Who sacrifices?
This is what this blog is about.
Further, it is not just about what I think. Over time, this blog will make available a discussion forum and brief surveys (polls) so the readers, you, can make your opinions known, hopefully with a minimum of partisan politics.
I hope you will participate, and that you find this blog and related forums and polls to be useful, timely and engaging.
Steven Yergan, CEO, Health Tactics