Where’s the consumer’s voice in health care?
Let’s unleash the power of consumers to drive down costs by making doctors, hospitals, insurance plans and drug companies compete for consumers’ business. Just give consumers — including those covered by Medicare — big tax breaks or vouchers to buy their health care plans in the private market, and they’ll shop and barter for medical care and insurance the way they shop and barter for cars, furniture and other goods and services.
It sounds like a great idea, but Andy Serio isn’t buying it.
Serio has spent decades in the trenches of southeastern Wisconsin’s health insurance and employee benefits business, helping both public and private sector employers cobble together their workers’ benefit plans. As a result, he’s seen, heard and lived through a lot of health reform ideas from every different political viewpoint, and he’s known for having strong opinions about what he thinks works and doesn’t work from a business perspective.
Of all the reform proposals floated over the years, nothing seems to exasperate Serio more than “consumer-driven health care.”
“Consumerism is a good idea,” he says. “It just doesn’t work in health care.”
The reality is that individual consumers have limited choices in the health care system. If they’re lucky enough to get insurance through their jobs, they get a choice of one, maybe two, plans. They have no control over what the insurance companies charge, and they have no control over what doctors, clinics or hospitals charge, especially for big-ticket items like cancer treatment or cardiac surgery. To put it simply, consumers have no power to negotiate anything in health care.
To be clear, Serio isn’t blaming employers or insurance companies for skyrocketing health care costs. He’s just saying it’s naïve to think that giving consumers vouchers or tax breaks or making them pay thousands more in deductibles provides enough momentum — enough “competition” — to fix a broken system.
And, he’s right. Nothing short of a major, national overhaul will effectively lower costs, improve quality and extend health insurance coverage to millions of uninsured Americans. Tinkering around the edges isn’t enough when there are so many factors that add up to the United States spending $2.5 trillion on health care last year. Consumer lifestyles and the aging population are to blame, as are the profit-driven goals of the insurance industry, drug companies, medical device businesses and hospital systems.
Perhaps the biggest cost driver of all is American consumers’ unrealistic expectation that the U.S. health system can and should deliver the very best medical care without limitations.
So, while we wait for Washington politicians facing reelection to muster enough courage to pass dramatic changes to an industry that accounts for 17.3 percent of the U.S. economy, what — if anything — can we consumers do?
It sounds trite, but Serio suggests that if we can help it, don’t get sick.
“Consumerism in health care can work when it’s directed toward wellness and prevention,” he says. “Take care of your health. If you don’t, it will cost you more.”
There are many ways to encourage wellness and prevent sickness. We can exercise more and eat healthier diets to control our weight so that we don’t develop diseases such as diabetes. We can get immunized against the flu. If we have a chronic condition like high blood pressure, we can follow our doctor’s advice to manage it so that it doesn’t mushroom into something much more serious — and expensive.
We can also get educated and stay informed, which is what I hope this new column, “View from the Waiting Room,” will do for ThirdCoast Digest readers. Over the coming weeks and months, the column’s purpose is to provide news and views on national and state politics, business trends, wellness and other issues that impact the health and well-being of the people who live and work in southeastern Wisconsin. If you have a comment or idea to share for a future column, I’d love to hear from you.