A fix for health care

The Colorado Commission on Affordable Health Care has wrapped up its three-year study of rising health care costs in the state, adding key recommendations in four areas to complete a comprehensive list of factors in need of action or further study.

The 100-page final report, to be delivered to the governor and the Legislature, considers everything from utilization rates in rural health-care markets to drug costs to consumer confusion over free-standing emergency rooms.

Cost factors are woven together so tightly that pulling on any single thread implicates every other thread in the system, members of the commission told the Sentinel’s editorial board Friday. A combination of government intervention and self-motivated changes in the private sector must occur in tandem to bend the cost curve — neither of which is likely without strong leadership.

The commission’s work is too detailed to condense here, but it’s too important to sit on a shelf and gather dust. The report recommends state legislation where appropriate, identifies market forces for activities in the private sector that could lower costs and recommends lobbying the state’s congressional delegation on issues beyond the purview of state government, such as regulation of the pharmaceutical industry.

The debate over health-care reform raging on Capitol Hill has little bearing on the commission’s findings. The discussion that’s occurring in Washington, D.C., deals with access to coverage and the payments and funding of programs related to it, which generally have very little impact on the costs of the care being provided.

This report focuses on the cost of care and one idea that we think bears further contemplation is Maryland’s all-payer model equalizing hospital reimbursement rates, which has saved the state more than $1 billion since it was implemented.

Under Maryland’s 36-year-old Medicare waiver, all third parties pay the same rate, eliminating the “cost-shift” that results in more expensive care for the commercially insured.

The federal government agreed to let Maryland set rates for hospital services. The federal government pays more per visit for Medicare and Medicaid patients with the understanding that its overall costs will be equal to or less than what it would pay anyway under the national model. It means doctors have to look at a more efficient way to render care. That, in turn, affects levels of utilization for imaging, lab work, prescriptions, etc. — which drive costs — and puts a premium on keeping patients healthy.

While promising both in terms of cost containment and quality of care, pursing such a model in Colorado would have significant up-front costs and require intricate negotiations between government and the private sector.

Which brings us back to the leadership question. The commission had provided a road map to cheaper, better care but it’s going to take lawmakers, policy wonks, insurers, regulators, patient advocates, doctors and hospitals working together to choose a common path — one that put greater emphasis on patient outcomes than profit margins.


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This article points out what is wrong in limiting the discussion about healthcare to “how to”.  What is lacking in that type of thinking is that any valid healthcare system must insure that those in need of care actually get it.  It is therefore a humanitarian question, not merely one of economics. 

There are economic considerations to almost anything whether in the public and/or private sector, and those must be considered.  But to consider only the “how to” frequently eliminates everything else, including humanism and human beings.

We are, and almost on a daily basis, seeing companies and CEO’s increase the price of their drugs.  Those are “drugs” which have been around for quite a few years, and the cost of development has been recouped many times.  So, some of us ask the question “Why is the cost of those drugs rising?  The only reason is that these companies and CEO can do so, and for no other reason.

Some of us can also see that in other costs as well.  Only miles apart, one hospital will charge much more than another (very frequently much more).  Again, and recognizing that there may be some reason that they do so, the difference in those charges is all too frequently very difficult to explain.

Unlike most, when some of us want to truly understand things, we will dig down by speaking to those who are on the “firing line” prior to speaking to any elected public official, even representatives and senators.  We also do that at the local level as well.

What we have found is that, those individuals have failed to do that, but are acting upon pure theory, and really don’t know why things are happening. Therefore, what they do is resort to the old “It’s supposed to work, because I believe it should”, even though it really doesn’t and never has.  Allow me to put it another way, if you will.  So enamored of themselves because they believe themselves to be “right”, that they don’t take the time to look for any of the causes yet, at the very same time, will dismiss everyone else’s views and opinions, not recognizing something which some of us learned a very long time ago.  It is that individuals will always seek solutions in what they know (or believe they know), as no individual can do otherwise.

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