Ideology won’t solve health care crisis, but community cooperation could

In the cacophony of criticism and crowing that has followed the opinion of the Supreme Court on the Affordable Care Act (or “Obamacare”, depending on your partisan affiliation), I offer a still, small voice to note that, actually, both political parties — and the court — are correct ... in part.

The Democrats are right that something must be done to contain health care costs. Double-digit increases in any line of a household budget or a business’ overhead are simply unsustainable and unacceptable drags on the American economy.

Because those increases are seen in your bill from your health insurance company, the immediate reaction is to assume the industry is overcharging. In the interest of full disclosure, I have the honor to head up one of the best health plans in the country, a non-profit company that manages to a margin of 1 percent to 3 percent. By definition, if our margin is 1 percent, that cannot be the cause of a double-digit increase.

In fact, health care cost increases are driven by dozens of things, some good (new drugs to control cancer or innovative surgical procedures that turn a three-day hospital stay into an outpatient visit) and some not-so-good (the cost-shifting of the uninsured and government programs that underpay hospitals and doctors — you make up the difference, which makes your bill 30 percent higher than it would otherwise be).

Because the problem is compound and complex, any effective solution is intricate. But Democrats are right that any effective solution requires all of us to be a part of a system.

Republicans are correct that the most effective solution to the problem of spiraling health care costs is not a partisan piece of legislation, driven through Congress without a single Republican vote. Truth be told, there is blame on both sides of the aisle for this divide, but the fact remains that a purely partisan act of Congress is a terribly unstable framework for a long-term solution.

Republicans are also right that any solution requires more than a mandate. It requires rules that address market realities and individual choice.

The Supreme Court was right not to intervene in this political process, appropriately noting that “it is not our job to protect the people from the consequences of their political decisions.” In other words, if we elect President Barack Obama, we should not be surprised that we get a health plan that implements his vision.

The constitutional response to that is not to look to the court for better policy. It is to strive for a different outcome in the next election. The Supreme Court consists of nine judges who determine the constitutional parameters within which government must operate. It is not nine philosopher-kings (and queens) who set health care, or any other, policy.

Notwithstanding the correctness of Democrats, Republicans and the court on these issues, there is one thing that has not been said by any of them: Ideology will not lower the costs of health care. Higher quality leading to better outcomes, better access and superior coordination of care are the ways to do that.

In that regard, our system in Western Colorado does those things pretty well compared to other parts of the country. But — as any business or household in Grand Junction will tell you — we have not built a system with low costs. And, in fact, no community can build such a system by itself. It requires coordination with the federal government (which writes Medicare rules), the state government (which writes the Medicaid rules), the medical community and each consumer.

We don’t do that perfectly here. We just do it better than most other communities. That is not surprising.  It is in the DNA of the Grand Junction community to approach difficult issues collectively, as a community — from the school district budget, to a mentoring program for high school students, to the United Way, to the JUCO tournament. We address problems by working with each other, with an underpinning Western heritage of caring about each other.

Over the years, that has led to a high-performing health system that is admired by both sides of the partisan divide. Democrats can look to Grand Junction and value the broad access to mainstream care for the poorest individuals in the community. Republicans can look to Grand Junction and see a private-sector solution, based on individual choice.

All this creates an opportunity for us to be part of a larger solution, and there is a concomitant obligation for us all to rise to the occasion. In the end, we in the Grand Junction community have a chance to help turn down the heat, turn up the light and turn out high-quality health care that is more accessible and more affordable.

Steve ErkenBrack is president and CEO of Rocky Mountain Health Plans, headquartered in Grand Junction.


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