Health-care conundrums

BY TYLER HAKES | MARCH 10, 2010 7:30 AM

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Health-care reform as we know it would be more accurately described as health-insurance reform.

I say this because, for the most part, Americans and politicians in favor of the current legislation have focused on changing regulations on medical benefits and insurance companies. They haven’t made much of an effort to control rising health costs.

That needs to change, and young Americans need help to change it. If skyrocketing health costs are not addressed, then any improvements in the insurance industry will essentially be negated, because ballooning medical bills force them to raise their premiums.

“[Problems in the health-care industry] are not being addressed sufficiently,” said Samuel Levey, a professor of health management and policy at the University of Iowa College of Public Health.

Overhauling the insurance industry helps to solve the problem of accessibility. It would extend insurance to millions of Americans without it. The nonpartisan Congressional Budget Office has estimated that both the House and Senate bills would expand coverage to more than 30 million people.

But that does not fix problems with the health-care providers themselves. Last summer, Atul Gawande, a staff writer for The New Yorker, found some shocking things about McAllen, Texas, and our nation’s health-care system:

• McAllen’s high health-care costs are caused, in large part, by pure over-utilization: Doctors run more tests and provide more — in terms of quantity — care than anywhere else.

• McAllen’s quality of care is among the lowest in the country. As a national trend, areas paying the most for medical treatment are receiving the worst care, and McAllen is no exception. The Mayo Clinic in Rochester, Minn., ranks within the bottom 15 percent nationally in terms of cost of care, yet its quality is universally known as some of the best.

• Doctors stand to benefit, through referral incentives and profit-sharing, from over-ordering tests and procedures. There is a fundamental disconnect between the goal — the best possible, most effective care — and the incentive: getting paid by per procedure.

Scenarios such as those described in Gawande’s article outline how over-utilization can be one of the biggest drivers in increasing insurance costs. This isn’t a jab at physicians; it is the incentive structure in the medical world that creates the problems. After all, over-utilization isn’t inherently unethical. But, if unchanged, the system will continue to inflate costs and create problems for generations to come.

All of these effects — and the second-highest medical costs in the country (next to Miami) — occurred in Texas, a state whose 2003 tort-reform legislation was supposed to wrangle in medical costs by reducing malpractice-insurance premiums for care providers. This hasn’t happened.

While medical malpractice-insurance rates have fallen approximately 30 percent across the state according to the Texas Medical Association, health-care costs for citizens have continued to rise. A study released by the Dartmouth Institute for Health Policy and Clinical Practice in 2009 revealed that McAllen’s medical costs (for patients) were still rising at the highest rate in the nation — more than 8 percent annually.

Texas has served as the perfect case study for why tort reform is not the sole solution to climbing health care costs.

It’s apparent something needs to be done to bring health-care costs under control. “It’s a real problem; it’s imperative that they crack down,” Levey told me. “Otherwise, [costs] just keep spiraling up.”

Young people will feel the effect of letting these issues slip under the radar. If the current legislation passes and doesn’t address the problems that plague the medical world, we will face the same looming difficulties and will have accomplished nothing of significance.

We as a country — and specifically, our generation of young voters — must push for more responsible controls of health-care costs now, not later.

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