, Salem, MA

May 3, 2014

Column: We have met the health care enemy

Patrick Hughes
The Salem News

---- — If you’re not feeling dazed and confused by the health care system, you’re not paying attention. State reform, federal reform, broken websites and promises, seismic changes in the health care industry — all these developments are creating uncertainty for consumers, businesses, doctors, hospitals and health plans.

Without a doubt, the old system was broken. The traditional fee-for-service model — in which providers were paid per test or procedure instead of by patient outcome — drove up volume and cost. At the national level, my own industry, health insurers, erred badly in not fixing its own house by guaranteeing coverage and covering people with pre-existing conditions, as Massachusetts health plans have done for years.

The government fixes have gone a bit too far in some areas, however, fixing some things that weren’t broken and breaking some things that were already fixed. One example is a provision in the Affordable Care Act that deals with how risk is spread among individuals and small businesses purchasing insurance. The result is that rates for some of those individuals and businesses are going up as much as 100 percent. That’s just not fair.

What else can we expect? Our experience in Massachusetts, which was the basis for the federal Affordable Care Act, offers a glimpse into the future. When you cover everyone, cost quickly becomes the issue. Squeezing costs puts pressure on providers, which leads to consolidations, which lead to … higher prices. It also creates an adversarial relationship between providers and insurers, impeding the kind of cooperation that will be necessary to control costs in the long run. Public health care programs — namely Medicare and Medicaid — are going to expand without additional funding and, as a result, those paying for private insurance will subsidize a bigger and bigger portion of the cost of those programs.

So what are we to do? First, let’s stop passing health care reform laws for a while. Since 2006, we’ve seen a significant piece of state or federal reform legislation passed every two years. There are some good things happening in health care. Risk sharing by providers, which put the financial incentives in the right place, and limited provider networks (both pioneered by Fallon Health) are proving to lower the rate of cost growth. They are also beginning to reshape the delivery system — the way providers deliver care — where I believe the long-term solution to controlling health care costs lies. Let’s give these things a chance to work and get the benefit of some trend data.

Meanwhile, there are steps we can take to support and enhance these trends. Transparency — letting everyone see the real costs of specific care — could be transformative, but we need education and financial incentives to encourage people to use the information appropriately and make informed decisions.

But there is something even more fundamental that we need to consider. It’s easy to point fingers for high health care costs, and there is certainly plenty of blame to go around, but to quote the late comic strip Pogo, “We have met the enemy and he is us.” As citizens, we’ve become disengaged from the political system. With an average election-day turnout of 47 percent, we’re 138th out of 169 countries. Among the nations that do better: Syria, Somalia and Iran.

When citizens fail to get involved in our political system, it gets hijacked by others — special interests, political parties that push elected officials to the extremes, and candidates who try to out-bid each other with unrealistic or contradictory promises.

You don’t have to agree with my view on health care, but find one you agree with and advocate for it. This is an important political year — mid-term elections in Congress and a gubernatorial election in Massachusetts. So, for sure, vote — but aim higher. Learn the candidates’ positions and support one. Make a contribution. Stuff envelopes. Staff a phone bank. Write a letter to the editor. Run for office yourself!

To paraphrase Orlando Sentinel columnist Charlie Reese from his final column, we should have the gumption to manage our own employees — those who represent us in government. We, the people, have the ability — and the obligation.

Patrick Hughes is the president and CEO of Fallon Health. He was the keynote speaker at the North Shore Chamber of Commerce breakfast event on April 2.