The Health Care Story – Let’s Rewrite It

The best stories come from curiosity…” – Steven Brill, author of “A Bitter Pill: Why Medical Bills are Killing Us

A program of UHCF of CT.

On Monday I attended an inspiring forum on the current challenges of Connecticut’s health care system led by the Universal Health Care Foundation of Connecticut, a group I love for their tenacity and conviction in driving health care reform in the state. I was really excited to be at the forum (“Reform to Transform”) alongside other residents who are looking for answers to rewriting our health care story.

Steven Brill was the headliner, and someone I was excited to hear speak ever since watching him on The Daily Show with Jon Stewart many months ago. During that first introduction to Brill I found myself shouting at the TV – something I often do as I so readily agree with Stewart’s practical, matter-of-fact reflection on the issues of the day. My shouts on that particular night were to the tune of “Amen” and “I’ve been saying that for years!” as Stewart questioned Brill on the investigative report, “Bitter Pill” he had written for Time magazine.  The report, and the discussion of that evening, focused on the core issues that make our current health care system so unsustainable including:

  • No true security in health insurance, with plans that drop patients or fail to cover essential treatments.
  • Costs that contribute to 60% of all bankruptcies in the country.
  • Exorbitant prices that disregard fair market pricing.
  • Profits made on human services in an inhumane way (i.e., CEOs and medical manufacturers making millions while health care workers and patients suffer).
  • The built-in demand for services (i.e., you could die if you don’t access care, so consumers have no choice or leverage).

What’s Your Story?

As Steven introduced himself on Monday he shared the impetus behind delving into the health care system, a journalistic curiosity fueled by the realization that everyone has their own health care story. Either you or someone you know has had frighteningly high medical bills at one time or another.

It is a topic that is universally relatable, and the widespread consequences of this issue make it important for everyone in Connecticut, and the country. The packed auditorium offered assurance that many are awake to this fact and want to know the potential solutions that the panelists: Patrick Charmel, CEO of Griffin Hospital; Kevin Lembo, Connecticut State Comptroller; and Brill, had to offer.

The Price is Too D*** High!

If Jimmy McMillan had been at the forum I’m quite sure he would have proclaimed health care costs are “too damn high!” That was a theme that each of the panelists reflected loud and clear. Lots of money is being made in the industry, but not by those who are actually providing the care. The biggest share of profits go to medical equipment manufacturers, pharmaceutical companies, and insurance execs. None of those parties have any incentive to lower costs because the consumer is under the illusion, and often the reality, that they have no control.

As Charmel pointed out, in his dealings with insurance companies he has found, “there’s no incentive to lower premiums.” Kevin Lembo agreed that for years the state of Connecticut has relied on the insurance industry, which is largely housed in the state, to whittle their rates down. But, that simply hasn’t happened.

In fact, as Brill noted after doing a little comparison shopping on the new online exchange, the cost from premiums in New Haven Country are higher than some of the wealthiest burrows of New York City. Clearly insurance rates are not based on a consumer’s ability to pay, but rather a toxic soup of other factors that often make it unreasonable for the average Connecticut family to afford.

The System is Too Complicated

Brill also noted that in his recent reviews of Access Health Connecticut, the online exchange in the state, it was very difficult to understand why premiums varied widely. More importantly, it was unclear how to determine the quality of a particular plan. There were ratings exhibited by stars, but there were no explanations as to what those stars meant.

As he put it, “most people, even if you’re really well-trained, will have trouble figuring it out.” I have to agree with that statement, because although I haven’t yet attempted to utilize the state’s exchange, I was challenged with purchasing a medical plan several months ago. Even though I have worked in the health insurance industry as well as the health care industry, and I have been a regular user of the system as a patient, it took me several weeks to sort out all the different plans.

I was trying to balance the cost of deductibles, premiums, and copays with the future level of care I needed and could afford. Although I used logic, it ultimately felt like I needed a crystal ball to make that decision. I did have information to work with, as I was using which aggregates different plans and allows you to sort by cost and insurer (similar to what the new online exchanges do). But, I don’t really know if I was truly getting the best value for my needs.

Costs Must Be Transparent

The reason I couldn’t really assess value is because as a consumer I don’t actually know what anything costs. That is the piece of the health care story that makes it a mystery. All three panelists seemed to agree strongly on the point that what the industry needs most is transparency.

There should not be secretive contracts between insurance companies and hospitals or negotiated rates that consumers aren’t privy too. As a patient with Hashimoto’s Thyroditis (a very common condition) who avoids most conventional medicine in favor of natural healing, the only regular health care costs I must incur are lab tests. Yet, how can I possibly decide if I should go with Aetna or Anthem as my insurance carrier when I have no idea what either of those companies will be charging me for those lab tests?

Believe me, I have asked. In fact, I often ask at the lab before I have my blood drawn, only to be told “we don’t have that information; it is up to what your insurance company has negotiated.” I have even heard of cases in which the rate that patients are charged when they use their insurance is more than what the service costs for consumers without insurance. It probably wouldn’t even occur to anyone to ask about that, but as consumers we should.

Consumers Must Be Involved

Indeed consumers must demand as much information as possible going forward. If health insurance is going to be mandatory, as I personally believe it should be, it must also be completely open to free market principles of supply and demand. No secret negotiations. No special contracts with medical manufacturers.

And, if a consumer wants to know what something costs, they should be able to get that info with a quick search on a website or in a five-minute phone call. There again was no debate from the panelists on the issue of consumer involvement. In fact, it is an imperative according to Lembo who manages the health insurance costs of over 200,000 state employees. He sees firsthand that consumers often unwittingly drive the sky-high cost of care by utilizing emergency services when they should really just be nursing a cold with bed rest and plenty of fluids, or they should be selecting hospital services by comparison shopping first.

Patrick Charmel agreed that in order to give Connecticut’s health care story a happy ending, incentives must be built into the system to encourage everyone to live healthier lifestyles. As a Dietitian and Health Coach, I hope such incentives will become a reality, because right now they simply seem like a fairy tale.

Consumers are used to accepting that to be well they must see their doctor, take costly medications, and have surgery as a quick solution, when in reality we all have the ability to rewrite our own health care story through natural healing. We the people need to take control of our own care to make the Affordable Care Act truly affordable and viable for all.

UHCFFollow the Universal Health Care Foundation for more on ways you can stay involved, or for those outside of Connecticut, get tips for navigating the system through Consumer Reports Health Insurance site.

Have any ideas on how you can rewrite your health care story? Please share below….

Leave a Comment

Your email address will not be published. Required fields are marked *