FEEL FREE TO CORRECT ME (I’M SURE SOMEONE WILL) I’VE ALWAYS PAID ALL OR PART (EMPLOYER PAID SOME)OF GOOD HEALTH INS FOR MYSELF AND MY FAMILY THROUGH MY JOBS EVEN THOUGH COSTLY.

4. ONE MORE IS THE COST OF PERSCRIPTIONS. MY DAD JUST GOT 4 ENFUSIONS IN THE LAST 6 MONTHS AND WE DIDN’T FIND OUT UNTIL ALL FOUR WERE OVER THAT THE TREATMENTS WERE OVER $10,000 EACH MOSTLY FOR THE MEDS. AT 85 AND ON A FIXED INCOME THAT IS TOUGH, THANKFULLY HE HAS INSURANCE AND MOST OF IT WAS PAID FOR. I’M SURE THAT MOST OF THE COST IS FOR TESTING AND RESEARCH BUT SOMEHOW SOMETHING NEEDS TO BE DONE IN THAT AREA ALSO??

I’M PROBABLY REALLY OFF THE MARK BUT I’D LOVE TO HEAR YOUR FEED BACK.

With respect to the baby boomers (although I disagree that 40-somethings should be lumped together with the older boomers), a recent study points out that that the first wave of boomers (1948-1953) are experiencing more chronic health problems than previous generations. While this accounts for more health care spending and increased costs, rather than concentrating on getting the consumer to pay attention to the cost of health care, how about working on better health education in which doctors can speak intelligently regarding protocol and diagnostic standards. Ambiguity abounds with regard to many “standard” preventive tests and intervention procedures (take the current “stent” debate, for example). How can bias be reduced in medical studies in which drug companies & equipment manufacturers are involved????

As consumers, all we can do is conduct our own research
and seek out second (and maybe even third) opinions when in an ambiguous medical situation.

Paul Levy makes a bunch of interesting points (as usual). I’d offer up the following thoughts in response. First, there’s hope in the legislature for enough money to adequately fund the Health Care Quality and Cost Council. While the Patrick Administration filed only a few hundred thousand dollars to get this this up and running - which is simply not enough to do this job right - several House members (led by Rep. Pat Walrath - House Chair of the Health Care Finance Committee) filed amendments to the House budget to bump the number up to the $1.3 MM requested by the Council Board. That would be enough to get the Council off and running.

And while I share Paul’s basic conviction that information alone won’t change either consumer or provider behavior, it will change the conversation - and that - by itself, can change behavior over time. Look at smoking, drinking and driving, automobile safety, air bags, water and air pollution - just to name a few. Public debate changed on these issues - and so did behavior, policy, oversight, etc., as a result of that changing information dynamic. It’s not the end game, but it’s a critical place to start. And frankly, given the forces driving items 1,2 and 3 above, it’s hard for me to see how anything other than sunshine on the data disrupts this gradual drift in the wrong direction.

Where I might “shop” around is for good preventive and well care. Most primary care offices fall short on the counseling and promotion of healthy lifestyles. They have not embraced the philosophy that made managed care attractive to consumers initially - perhaps due to lack of time, costs and training. It seems to me where managed care failed was not having enough professionals promoting healthy living and treating individuals as a “whole person” so that people could start making that connection. Typically, the expectation from seeing a doctor is that you’ll walk away with a treatment usually it’s a prescription. If I’m overweight I want a pill… if I cry I want pill etc.

National insurances are starting to recognize both complimentary and alternative health care and offer a network to membership with both benefit packages and discounts. There are very few naturopathic physicians practicing in MA (state is lagging behind with their licensure) but they are starting to offer discounts to members of plans that offer the coverage nationally, i.e, Blue Cross.

My point here is that when we or a loved one develop an acute illness/disease, we want to get great and speedy care no matter what it costs. The real challenge to avoid getting in that predicament.

Every hospital knows its costs. And so does the public, whether published in the financial section of our Forms 990 filed with the government; our publicly available financial audits; or our bond prospectuses. In addition, the number of our discharges and outpatient visits is likewise available in a variety of places.

As we have discussed below, what is not public are the rates we are paid by each insurer, although the total revenues we collect are public.

As insurers, you have the best indication of what’s driving up overall health care costs because you pay for most of it. You have summarized the main components: 1 -greater utilization of services by an aging (and sometimes entitled!) population; 2 - greater utilization of higher end services, i.e, specialists and procedures; 3 - a shift from lower cost institutions to higher cost ones; and 4 - drugs (both drugs that add value by substituting for clinical procedures and hospitalization and extend lives, and drugs that are advertised to the public as being essential when they are really not.)

I don’t know what can be done about #1, and I see an acceleration of that trend as we narcissistic baby-boomers reach our 60’s and older. #2 would best be solved if PCPs were paid well enough so that there would be enough PCPs around, so they had the time to spend with patients, and so ultimately people could be persuaded that not all problems require a specialist. #3 seems to be a case of people voting with their feet, believing (often wrongly) that the downtown hospitals offer better quality than the community hospitals — and where publicity of actual clinical results could help persuade them otherwise. And, on #4, a variety of approaches, some of which you mentioned.

As long as consumers don’t pay the actual rates charged by doctors and hospitals, they will not respond to information about those rates. As long as insurance reimbursement rates are based mainly on factors other than clinical results, they will not reflect the proper value of services offered. As long as my colleagues in the industry and the government and insurers stall on the release of real-time, accurate information on clinical outcomes, there is no way for society to assess the relative success of different hospitals in providing value to the public. The Health Care Quality and Cost Council would be a good place to start if it had been given the authority and budget to do the job you set out — but the new health care legislation failed to provide that authorization.

I think a lot more effort could also go into reducing utilization in end of life situations. Perhaps we could require that everyone have a living will or advance medical directive to avoid providing care that the patient may not even want but can no longer communicate that fact. Or, maybe hospice care or palliation could become the default protocol if it is clear that life expectancy is less than six months unless there are clear instructions to the contrary. In any large patient population, roughly 5% of the people account for 50% of the costs. The high cost cases could use a lot more attention and focus.