Greenwich Time Op-Ed: Health Plan Good Start But Must Control Costs More

Op-Ed

Greenwich Time Op-Ed: Health Plan Good Start But Must Control Costs More

For the first time in almost two decades, Washington is addressing our broken health care system, and none too soon. As Americans continue to lose their jobs at a gut-wrenching pace, they often face a terrifying fact: lose your job, and you lose your health insurance.

Our health care system is a moral embarrassment and an economic liability. More than half the personal bankruptcies in the U.S. are caused by unexpected health care expenses. Small businesses choose between uncovered employees and huge insurance premiums. Cancer patients have seen their insurance companies deny them care at the moment they need it most. And most of us have experienced the frustration of having our insurance company come between us and our doctor.

Almost everyone feels the pain of spiraling out-of-pocket health expenses. In Connecticut, over 350,000 people have no access to health care. Those of us with insurance pay about $1,100 extra each year in premiums to cover their costs. Health care costs have doubled in the last ten years and will do so again if we do not act.

Health care reform must have two primary goals: provide Americans with stable access to high-quality care, and substantially reduce the costs in the system. Fail in the first goal, and we will continue to live with the moral and economic costs of a broken system. Fail in the second, and we will simply accelerate the unsustainable trajectory of this system.

The reform proposal being discussed in the U.S. House of Representatives does well on the first goal. It would cover almost all Americans, and provide subsidies to those households unable to afford it. The plan allows those happy with their current coverage to keep it, while creating a competitive "exchange" in which private insurers and a public option would compete for customers without employer-provided coverage or who choose to forego it. Think Orbitz.com for health insurance.

The proposal before Congress will bring peace of mind and stability to families and businesses across the country. By making affordable individual health plans a reality and prohibiting exclusions for pre-existing conditions, the plan guarantees you can obtain health insurance regardless of your employment situation. Additionally, the plan will reduce costs for seniors, who will no longer need to worry that the Medicare "doughnut hole" will impoverish them.

The public option has been the subject of much debate. Properly structured to assure a level playing field, a public option will provide much needed competition for the insurance companies and help bring down costs nationally, given that 90% of Americans live in markets dominated by one or two insurers. To those who worry about government participation in the market, remember that it is a public option - no one is forced in.

Unfortunately, the proposal before the House is weak on the second key goal: cost reduction. Remember, we spend twice per person on health care as other industrialized countries, with subpar results. That is the very definition of inefficiency.

Change will not be easy.

We must revisit our current fee-for-service, volume-based model, in which every provider at every step has powerful incentives to order test after test, procedure after procedure, with little regard for what is actually effective.

Instead we should reward hospitals and doctors who deliver higher quality health care. Doctors and patients need access to the best information and evidence on effectiveness. True health care reform must encourage proven best practices, like increasing nursing staff and coordinating care among a patient's entire medical team.

Cost control also requires that we actually start emphasizing health. Few in our current system have an economic incentive to keep Americans healthy—payment follows diagnosis, therapy, treatment and cure. We severely underinvest in the early medical care and education that can lead to a lifetime of healthy habits. Estimates suggest that nearly 10 percent of the costs in the system are associated with obesity, which is just one of the preventable health issues that afflict too many Americans.

The bill is moving in the right direction, but it falls short of the fundamental reforms that will reduce costs in the system and incline it towards actually keeping Americans healthy. Congress is abuzz with the process, with all its passion, partisanship and emotion. Success is critical, because the status quo is no longer an option.

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