Curbing Runaway Health Inflation

The August 2nd “New York Times” editorial “Curbing Runaway Health Inflation,” http://bit.ly/qT3BY suggests that “Congress should not slow the push for near-universal coverage while it looks for ways to apply the brakes to the growth in costs.”

While the discussion offers a few suggestions to curb health care spending, such as implementing electronic medical records, increasing taxes, limiting the influence of lobbyists and experimenting with the current Medicare model, they are but only baby steps in the big picture of true health care reform.

To reform health care in America, we must take a step back and evaluate what’s truly affecting our health economy. We must summarize for every person in America the real facts about their health. I don’t mean supplying broad generalities about our health care system; I mean deeply personal information about how 50% of us receive really substandard health care that leads to our own suffering. This suffering is physical and mental and made worse when often accompanied by increased health debt that may cost us personal possessions like our home or other necessities of life.

All of this substandard care is occurring while congress, insurers, physicians, and pharmaceutical companies lobby for their own prosperity, which, in many cases, is not in our best interest. These actions are not the “changes” promised by President Obama during his election campaign. Rather our government’s irresponsible behavior seems to perpetuate our national health malady because the same failed efforts of the past to control health costs are continued today. The national discussion so far has not been about a proposal for “change.” The discussion has been about how to rationalize special interests versions of preserving the status quo.

When we all have access to the true status of our individual and collective health, these conflicts of interest will vanish faster than a school of bate fish that scatters when threatened.

Empowered citizens when armed with clear understanding of their individual health and our collective health, will define a clear path to reform. It’s that simple.

So what is it that we do not know? First and foremost, we waste a lot of money fixing our bodies because we don’t maintain them when we are feeling well and ironically we don’t maintain them even when we have chronic conditions and are not well. We try to fix ourselves only when we really break down.

In some health plans with rich benefits that provide for preventive health, over 50% of people with rich benefit coverage fail to follow common sense guidelines for preventive health. Either people actively refuse to follow known guidelines for prevention or they have not been reminded what their preventive schedule requires. In some studies as many as 50% of us fail to undergo cancer identification tests, follow basic guidelines for diabetes management, refuse to detect coronary artery disease early, or manage asthma, musculoskeletal disease and pregnancy according to known high quality care standards.

In addition, 10% of all people on multiple drug regimens suffer from adverse drug reactions and are not aware of their plight. Often when people on multiple drugs seek attention for their symptoms they are treated with yet another drug, undergo expensive unneeded tests and procedures or simply they die and their families never really know the cause of their death. Paradoxically, some people take the right drugs for the right conditions, and yet get sicker. Their adverse drug reaction may not be diagnosed because their doctor and their hospital do not take advantage of new available technology that detects these costly adverse drug reactions.

According to the Institute of Medicine an average of $5,000 of every hospital stay in America is due to adverse drug reactions. Each of us needs an accurate report card that is a summary of the steps we have taken or need to take to comply with our individual health requirements.

Similarly, our health plan sponsors need an actionable summary of their health plan performances so they can measure the value for what is paid to hospitals, doctors and pharmaceutical companies. A summary medical performance index measures not only what we expect to get when we buy health, it also measures what we actually get when we pay for health.

The only way to overcome inertia preventing successful change in our health system is to mobilize each of our citizens with useful information about his individual health and then to show how collectively we impact each other's health costs. Then there will be change because all of us will know what to demand. For more information on how we can all get more value out of health care

The Health Gadfly