Controlling health care’s rising costs

Earlier this month, members of The Gazette Writers Circle discussed the question: How can we reduce the cost of health care and still get the care that we need?

Using a National Issues Forums guide on the topic as their starting point, the group considered three options: learn to live within our means; make the health care system more transparent, efficient and accountable; and take responsibility for lowering health care costs by focusing on wellness.

Many factors contribute to skyrocketing costs

Steve Chamberlin

Americans like to think of ourselves as leading the world. We definitely lead the world in health care spending, accounting for over 17 percent of our gross domestic product. Most other developed countries spend 9 percent to 12 percent of their GDP on health care.

Although we are the leaders in this case, that doesn't mean we are the best. We trail most developed countries in life expectancy, infant mortality rates and other common measures of health. So why do we get so little bang for all those bucks, and what can be done about it? The Gazette Writers Circle had a lively discussion on that topic, and several themes emerged.

We spend too much money at the end of life. About one-quarter of Medicare costs are spent in the last year of life, often on treatments that extend life by only minimal amounts and may not result in any quality of life. As a society, we're not good at having honest discussions with our doctors and our families about such treatment and we're also reluctant to allow the government or insurance companies to make those decisions by limiting treatment.

That's the perception that we had, although the individuals in our group were quite vocal about not wanting to prolong our own lives unnecessarily. Several in our group would want someone to 'pull the plug,” perhaps even in situations (such as advanced dementia) where there isn't a plug to pull. We think it would be helpful if more people had such discussions with their families when they are still healthy.

We spend too much money on preventable conditions. The American Medical Association estimates that 25 cents of every health care dollar is spent on the treatment of conditions brought on by our own behaviors. Obesity and inactivity lead to diabetes, heart disease and other preventable conditions. Smoking has declined significantly in the past 50 years, but still leads to many cancers and premature deaths.

How do we encourage people to take better care of themselves? Employers can offer fitness facilities and government can create more walkable cities and better access to fresh foods, but individuals also have to take responsibility. With current trends in obesity, we may see a generation with life spans shorter than their parents.

We spend too much money on technology and specialists. More equipment and more specialists leads to more expensive tests and procedures, which aren't always necessary. We need to encourage more doctors to become primary care physicians, which can result in lower cost care and less expensive medical interventions.

There is a lack of transparency in medical pricing. Consumers will shop around for most services, but it's very difficult to contact a hospital or doctor's office and get a straight answer as to what a procedure will cost. It's hard to know what the cost is until after the process is over and you find out what the negotiated rate is through your insurance carrier, and you still don't know what the cost would have been somewhere else.

So what is the solution? The current system appears to be unsustainable, as it continues to take an increasing share of gross domestic product at costs that are unaffordable for people well above median income levels. Clearly there are steps that individuals can take to slow the rate of increase, but those are unlikely to be sufficient to bend the cost curve.

It's a complex problem without easy answers that won't be solved with partisan finger-pointing. It will take honest and open discussion and the willingness to make tough choices. One member of our group commented that we usually have to hit bottom before things change and the 2008 financial crisis wasn't quite severe enough. I hope it doesn't take a similar health care crisis to develop the political climate necessary to find solutions.

We have the answers, but do we have the will?

Russ Gerst

Is health care a right (human, Constitutional, other)? Does personal responsibility really make a difference? What about the costs of health care associated with an accident? Should corporate profits come before the better interests of a community's overall health?

A large number of Americans are one major health crisis away from personal bankruptcy. A recent study reported on CNBC concluded that the number-one cause of bankruptcy filings in the U.S. is the inability to pay medical bills.

Discussions relating to this topic among Writers Circle members ranged from the McMansion-like urban hospital facilities, with their private suites and cater-to-every-whim mentalities, to the near indecipherability of hospital billing statements. Gone are the days of International Classification of Diseases (ICD) or CPT (Current Procedural Terminology) codes on statements that can then be understood related to services billed.

It is common understanding that any form of emergency hospital stay that includes a surgery or intensive care stay will range from a few tens of thousands of dollars to well over a $100,000 for any extended illness or injuries due to an accident.

As our conversation focused on power brokers in the current system, it became apparent that those raking in the enormous fees have strong political connections.

Likewise, the political establishment - particularly since the Citizens United decision of the US Supreme Court - is fully beholden to those entities with large volumes of campaign cash. The healthcare industry (hospital chains, durable medical equipment suppliers, drug manufacturers, major insurance companies, not to mention major physician networks) have deep pockets and are more than willing to flex their financial muscles to maintain the status quo.In the backdrop of the Obama Administration's effort to make health care access more affordable through the Affordable Care Act, it was readily apparent that private, for-profit insurance coverage was to be maintained at all costs. Legislators scuttled a proposed single-payer (Medicare-for-all) approach even before negotiations on the bill began.

So, is health care a right? When a person is injured, do we sit back and ponder whether the particular individual is worthy of care (do they work hard enough to deserve medical assistance)? What about children? People with disabilities? The elderly? Medicare was developed to ensure seniors would not have to decide between food or medical care. Private insurance at the time was more than happy to allow the most costly time of life to be managed by the government.

Why not allow those wishing not to deal with the private insurance profit bonanza to 'opt in” to Medicare? What about allowing businesses struggling to manage their health benefit costs to also 'opt in,” paying an additional payroll tax rather than face the uncertainty of annual private insurance increases?

Again, the answer isn't that we can't solve the problem, the real issue is what do we have to do to stop the moneyed interests from preventing the answers from being implemented? Which candidates for all levels of office are talking about precisely these issues? At what point do we as a people stand up for our rights and take control of our health care? The Affordable Care Act has increased access and is starting to bend the cost curve as predicted. But, is that enough? Slower increases in cost are still increases. Do we deserve more accountability and peace of mind than what the current system provides?

l Members of The Gazette Writers Circle meet monthly to discuss local issues and write opinion pieces about their discussions for The Gazette and online. More information: (319) 398-8469; editorial@thegazette.com