Wednesday, September 28, 2011

Health Care Cost Insanity Continues

The invaluable Kaiser Family Foundation released its 2011 Employer Health Benefits report yesterday. The findings are ugly.

150 million Americans get their coverage through employer-based programs. Last year, apart from the tragedy of increased unemployment, wages increased by 2% but premiums went up by 9%. The average cost for family coverage was $15,073.

From the perspective of workers, health care costs strangle wages and job creation. From a U.S. perspective, health care costs strangle other investments that could create more human value. And from a global perspective, it's disgraceful that we spend so much on health care without commensurate benefits while people in poor countries die from readily preventable causes.

A quote in a New York Times article about the report partly explains the mess we're in:
“We’re at a watershed moment,” said Elisabeth Benjamin, who represents Health Care for All New York, a group of 100 organizations advocating affordable care. “The Cuomo administration has to decide, will the Department of Insurance stand up for the little guy, John Q. Public, or let the insurance companies get away with this nonsense?”
John Q. Public is indeed getting shafted, but pointing at insurance company "nonsense" won't get us anywhere. Insurers will blame providers for raising prices. Providers will blame (a) their own costs, (b) Medicare and Medicaid payments, and (c) demand from the John Q. Public, whose advocates blame the insurers.

This circle of unproductive blame allows the inexorable cost escalation process to continue. Each stone the blamers cast has truth in it. But the stone casters are reluctant to acknowledge their own sins. We'll only get a grasp on our pattern of cancerous cost escalation through coordinated action among the currently warring stakeholders. That ultimately requires political leadership. We're not likely to get that leadership until we have an overall budget for health care, whether through a single payer system or through a system of not for profit health insurers as envisioned by Zeke Emanuel in Healthcare, Guaranteed.

In our current political discourse, the R word ("rationing") paralyses serious consideration of establishing an overall health budget. Budgets create limits, and limits lead to the accusation of rationing.

Some years ago, as part of a panel on rationing, a member of the audience challenged me by asking "Are you going to market your health plan by saying 'we ration care better than anyone else'?" For a moment I was nonplussed, but then I channeled Karl Rove and responded - "I would say 'we produce more health for every penny you invest than anyone else.'"

If a political clod like me could develop a communication strategy for detoxifying talk about health care costs and rationing, the political pros could show us the way if they put their minds to it!

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