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Health
Forum Explores Access and Affordability
Solutions
by
Judah Ken Freed
Anthem
leadership forum calls for physicians,
hospitals, drug companies, insurers, and
consumers to work together.
.
A
luxury 19th Century Brown Palace meeting
room served as the setting for an
afternoon meeting of regional health care
leaders convened to discuss those in the
21st Century unable to afford medical
insurance.
The 2002 Fall Health
Care Leadership Forum on October 29 was
designed as a work session for improving
health care access while reducing health
care costs, explained Caz Matthews, chief
operating officer of Anthem Blue Cross
Blue Shield in Colorado.
"We're worried about
not finding solutions in time to avoid an
impending system crash," she said. "We
believe physicians, hospitals, drug
companies, insurers, and consumers working
together can find the solutions we
need."
She outlined the
day's schedule. After an introductory
keynote, the ten tables in the room would
discuss assigned topics, then table leader
would present a summary of the
conversation, followed by a panel of
experts responding to the
recommendations.
Presenting the
keynote was Uwe Rheinhard, the James
Madison Professor of Political Economics
at Princeton University, on the board of
the National Institute of Health Care
Management, also serving on the health
care services board for the Institute of
Medicine within the National Academy of
Sciences.
He opened by
contesting the modern medical definition
of a "patient" as "a biological structure
who yields cash, not as a whole person who
needs health care."
Calling today "the
season of our discontent," Rheinhard cited
a Harris survey reporting 18 percent
believe the current system needs minor
change, 52 percent believe it needs
fundamental change, and 29 percent believe
the systems needs to be totally
rebuilt.
He discussed U.S.
per capita spending on health care
compared to gross domestic product (GDP),
which has grown from $1,000 per person in
1965 to $4,000 in 1995 to $5,500 in 2001.
Given current U.S.
trends, he said, per capital health care
will account for 17 percent of GDP by
2010, then 28 percent by 2030, and 40
percent by 2050.
He disputed that
prescription drugs are the chief driver
for rising costs in the $1.5 trillion
medical health care industry. For every
dollar spent, he said, drug companies get
9 percent, hospitals get 34 percent,
physicians get 20 percent, nurses get 7
percent, administration gets 6 percent,
and 22 percent goes for operations.
"I suspect the
gunsight of consumer advocates will soon
shift from the drug companies to the
hospitals, where consolidation is the
biggest driver of rising costs."
He claimed the
"tsunami of the Baby Boomer generation"
will turn out to be no more than a large
ripple in raising heath care costs
compared to all the other factors at play.
Pointing to Europe's
"public utility" model of lifetime health
security, he lauded the economic benefits
from a more healthy population, such as
coming to grips with the causes of
national obesity, another driver of rising
costs.
He said health
consumers in America suffer from a
zero-sum game between doctors, hospitals
and the government, all busy shifting
blame. Ultimately, increasing access and
affordability is the job of consumers
developing "health literacy," practicing
prevention, and "demanding an end of the
shell game."
Table
chat
Next came
conversation at each table. The
recommendations were voiced by the "table
presenters," whom Matthews said had a task
as difficult as saying how to create world
peace in 25 words or less.
David Uppinghouse,
senior VP for Van Gelder Insurance, called
for a focus on quality. "Identify the
quality drivers for ROI," he said, citing
a return on investment by doctors taking
patients' calls outside office hours,
which cut emergency room admissions by 60
percent.
John Hopkins, CEO or
Rocky Mountain Health Plans, discussed
smart cards carrying individual identity
and health history. His table also
explored lower premium incentives for
healthier lifestyles, perhaps tied to
catastrophic coverage as a "buy-up
option."
Janet Byrne,
Colorado's deputy commissioner of
insurance since August, said her table
favored insuring younger workers, tort
reform, income tax funding of health care,
and two years of mandatory national
service for all health care
graduates.
Lorez Meinhold,
director of the Colorado Consumer Health
Initiative, said an El Paso County
partnership between hospitals, providers
and insurers is providing access for the
uninsured, 80 percent of them employed.
Dr. Reginald
Washington, VP of the pediatric division
of Western Cardiology Associates, called
for standardizing benefits in Colorado
along with a health smart card to increase
efficiencies.
David Rivera, health
care policy analyst for Gov. Bill Owens,
advocated "a system that's independent and
self-supporting. Just as we give tax
incentives for small businesses, we need
incentives for improved personal
health."
Kay Norton, since
July the first woman president for the
University of Northern Colorado, said that
"employers are as mad as hell" about the
high cost of group health insurance. "The
answer is a personal medical savings
account that's portable from job to job."
Dr. David Scanavino,
CEO of Physician Health Partners, said
quality assurance reporting is too
voluntary with no consequences for
failure. "We need required government
reporting tied to long-term incentives for
improving patient outcomes."
Liz Leif, a
consulting actuary and president of Leif
Associates, said her table wanted to ban
all prescription drug advertising plus ban
financial incentives for prescribing
doctors. "The money saved by the drug
companies could be better invested in
research."
Colorado Senator
Dave Owen, R-SD16, a member of the Joint
Budget Committee, called for the repeal of
the 1996 federal Health Insurance
Portability Accountability Act
(hipaa.com), created to standardize
industry transactions. He also suggested
tax breaks for doctors providing pro bono
health services.
Panel
Responses
Table reports
complete, now the panel began to respond.
"In a free-market
system," said University of Colorado
Hospital CEO Dennis Brimhall, "it makes
sense to educate health consumers, and I
see that being supported, but the
uninsured issue does not have a high
enough profile in public policy to be
resolved now."
"Forty percent of
what we doctors do has no basis in
clinical science," said Anthem's executive
VP and chief medical officer, Dr. Samuel
Nussbaum. Eliminating medical mistakes
with more certain knowledge, he said,
"will free up lots of money for helping
the people who need the most
help."
The manager of
health and wellness benefits for Coors,
Jacob Lawrence, opposed the co-pay system
because it fosters a disconnect for
consumers between the costs and charges
for health services.
The associate
director of Plan de Salud del Valle in
Fort Lupton, Dr. Vergilio Licona, observed
that the uninsured rarely can afford the
initial health care expense necessary for
earning a tax credit. As for America
having the greatest health care system in
the world, he said, "Let's stop fooling
ourselves. The UN ranks the United States
37th in the world for overall health care
quality, not first. That's because health
care should be for people, not for
profit."
Caz Matthews
concluded with her own "take-away" points
&emdash; more public education to promote
healthier lifestyles, industry
partnerships and incentives for quality,
more federal funding for state Medicaid
operations, and the need for Colorado to
learn from other states.
With a round of
applause, she adjourned the session to an
adjoining banquet room where participants
enjoyed a free wet bar and the haute
cuisine of the Brown Palace &emdash;
representing all the nutritional food
groups, of course.
Orginally
written for The Colorado
Statesman.
November 2002
(c) 2002-03 by Judah Ken Freed
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