Mt. Vernon Register-News

October 15, 2013

Do we have the will?


The Register-News

---- — I received an article today with a suggestion for my column.

The article was written by Reed Abelson about a new path being taken by a large company — General Electric — and others in rethinking health care for their folks. The article addresses how the new federal health care law that we hear and read so much about is forcing them into redesigning their coverage policy, and in some cases even consider discontinuing employer provided coverage altogether.

One comment, “They are motivated by a need to rein in health care costs, which continue to rise faster than inflation, but also changing how some of them view their obligation to their employees”.

Does this not make you shudder? What is wrong with our political leaders that they cannot see past their need for campaign funding and realize that we cannot survive with per capita cost that basically doubles the cost of every developed nation in the world? We are going to create a whole new industry of so called “health exchanges” with benefit consultants, lobbyist and government and state outsourced groups profiting from the disaster. Another example is of a major firm giving those who qualify money to buy insurance on a private health exchange.

The article really hones in on one giant company that spends more than $ 2 billion a year offering coverage to 500,000 employees and retirees and their families that is seeking a new path to work directly with doctors and hospitals to improve care and reduce cost. Has anyone in our state, county, city read or heard of any plans to improve quality and reduce the cost of health care? They report that in one city about 118 doctors practices have converted to medical homes and all five of the major health systems are making their primary care practices move in that direction. They describe “medical homes in the article as “individual medical practices closely coordinates patient care by having access to all of the patient’s medical records”.

Another quote from an executive vice-president of one of the systems really captured my attention: “We are clearly gearing up to change directions from a traditional fee for service for what he calls “payment for value”. I think I have heard this called “outcome based” compensation in the past.

They give several examples of how a medical home appears to resonate with employees and in the city described in the article that early results show promise: “patients enrolled in medical homes had 3.5 percent fewer visits to emergency room and 14 percent fewer hospital admissions.” They are asking an outside firm to do a more detailed analysis.

They report that some companies have decided to send at least some of their folks to the new “public exchanges”; I am not sure about how public the so called “public exchanges” are because the rumor is out that they are outsourcing some of the running of some of these exchanges. The reason for sending some of their folks to exchanges with a monetary contribution to buy policies is that because of employees’ low incomes they believe they will be eligible for federal subsidies to buy coverage.

A few of the larger major employers are aggressive in trying to change how health care is delivered in this country. They are looking to make direct connections with health systems with institutions that can deliver care for expensive procedures. The company described in the article signed agreements with a high-volume orthopedic hospital, to oversee the care of some employees getting hip and knee replacements. Another large company reportedly contracted with Cleveland Clinic, Mayo and Geisinger, among others to take care of transplant, heart and spine care with plans to extend to other centers of excellence.

The article reports that this doesn’t sit so well with some local providers, but the large company primarily focused in the article is unapologetic and states they will continue to try a variety of approaches until it finds a way to tame health care cost.

I have been writing on this subject for almost 10 years with my first letter to the editor in 2004. I guess that I am just too naïve. If health care cost for our country is such a dominating subject and approaching 20 percent of GDP. I keep referencing GDP when comparing us to Japan, Germany, France and other developed nations; US 17 percent, Germany 11.3 percent, Japan 9.6 percent, France 11.6 percent, etc., so here is a brief explanation of GDP: Gross domestic product (GDP) is the market value of all officially recognized final goods and services produced within a country in a given period of time. GDP per capita is often considered an indicator of a country’s standard of living.

Let’s just cut to the chase: We need and deserve Universal care with a direct pay system and all the gobbly-gook about exchanges and 50 different insurance plans will not lower the cost to a competitive level in the global arena. The per capita just means per unit of population so when we state U.S. $85,00; Japan, $3,213; Germany, $4,495; France, $4,118; U.K., $3.405; etc. We are just showing how totally out of line we are on cost with life expectancies reportedly lower than all of them.

Our government could solve this problem, but the billions paid to their campaign coffers by the health care industry, insurance industry, Drug producers and others will not allow it. Put everyone on Medicare, Put the ones who defraud the system for a reported $60 billion in jail, wring out the waste with 30 percent administrative cost, publicly finance elections and we can move on to other problems.

Our problem goes deeper than just the runaway cost of health care. Our problem is, do we have the fortitude and character along with our love for our kids and grandkids to start voting them out until we force by election the sea change we must have? You tell me! Do we?