10 Questions on Rising Health Care Costs
Wisconsin has 4th highest costs in nation. When will our leaders take on the issue?
Ascension Columbia St. Mary’s Hospital. File photo by Coburn Dukehart / Wisconsin Watch.
How about a little quiz on one of the nation’s biggest issues that got almost no attention in the state and national midterm elections?
Quiz Question 1: What’s the second largest economic challenge facing the country? Roaring inflation is on top. In second, it’s health costs that are crippling the budgets of every private employer, government at all levels and households. The voracious Medical Industrial Complex (MIC) quietly and destructively keeps chewing up an ever bigger share of our economic pie. Health costs now consume almost $1 of every $5 of the U.S. economy (GDP).
Quiz Question 2: What is the projected increase in premiums for 2023 for the average American? Various projections put next year’s cost and premium increases at 5.6% to 7.4%. With health costs at least $22,000 for a family of four, the 2023 increase will be around $1,300 per family per year. That constitutes a major hit to family and business budgets.
Question 4: How is Wisconsin doing on health cost control? Not well. A Rand Corporation study put us at 4th highest in the nation. Froedtert Health is our highest cost/price system.
Question 5: Are there any answers for controlling costs? The best managed plans in the private sector bring in high quality care for about $12,000 per family or per employee, about half of the national average. Best practices at self-insured companies have worked successfully over the last 20 years to keep their people out of expensive hospitals and then steer them to centers of excellence for major procedures.
Question 6: Why don’t political leaders listen to business leaders who have reformed healthcare from the bottom up? Again, who knows? Politicians do a lot more talking than listening and learning. They are not students of management, the missing link in the health cost quagmire.
Question 7: Why does the MIC not use lean disciplines? American companies learned 20 years ago that they had to follow the lean business philosophies pioneered by Toyota and Honda. They learned they would get their asses kicked if they didn’t. Lean philosophies and methods eliminate defects and waste, resulting in dramatic quality improvements and deep cost reductions. Only a few health providers have taken the lean journey. Major buyers of health care could install quality and cost audits tomorrow. They audit every other kind of vendor.
Question 8: What is the primary building block for health cost reduction? Proactive primary care through independent on-site clinics keep people out of the hospital. Every American should have a medical home at the primary care level. It allows payers to control the front end of the MIC supply chain.
The best answer is totally transparent bundled prices that are being contracted by smart buyers in the private sector. They buy joint replacements for $16,000 to $29,000, versus an average charge of $50,000 to $60,000. Why would any intelligent system pay doubled prices for the same procedure?
Last Question 10: Why are drug prices so far out of control, including drugs that cost $50,000 a year and up to a half million dollars or more? The problem is so horrific that government regulation seems to be the only answer. Congressional and legislative hearings are needed to unravel the cost and benefit equations. Some of the expensive drugs bring near miraculous results. But, if they bankrupt families, can they be justified? I don’t have an answer on this question.
How did you do on the quiz? Probably no one did very well. The challenge of taking on the MIC is daunting, and its collusive leaders play the political game par excellence.
Instead of wasting time and energy on phony issues like “stolen election,” the leading lights in the political world need to elevate health care economics to front and center. There are answers out there.
John Torinus is the chairman of Serigraph Inc. and a former Milwaukee Sentinel business editor who blogs regularly at johntorinus.com.
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Do you remember when the Wisconsin Division of Health had a Bureau of Needs Review? I do. The Bureau’s responsibility was to ensure that the most costly services and equipment — at the time, MRIs, CAT scans, even “heart centers” — were distributed across the state, and *not* necessarily available at every hospital. While hospitals and health care systems create justifications for more and more costly equipment, sometimes it isn’t necessary, especially since we already have primary, secondary, and tertiary care facilities.
And Mr. Torinus ignores the elephant in the room — the huge additional cost imposed on health care in the United States by the existence of the insurance middleman in nearly every transaction, requiring coding, clerical work, insurance company executive salaries, etc.
Mr. Torinus, a bottom-up reform of the US healthcare system would be patient centered and focus on wellness. It would listen to public health experts who tell us that our highly processed corporate food system contributes to the increasing rates of type 2 diabetes (even among children;) it would pay attention to the impact of air and water pollution on the health of children (Milwaukee has an higher rate of asthma than metropolitan areas twice its size;) and examine how poverty, racism as well as other isms directly contribute to skyrocketing rates of infant and maternal mortality, cancer, cardio-vascular disease, neurological disorders like Parkinson’s, Alzheimer’s (and other forms of dementia.) A health system that was truly reformed from the bottom up would address the epidemic levels of gun violence as a public health emergency.
No Mr. Torinus, this country tried the business approach, and it failed disastrously. Developed countries like Great Britain, France, Germany, Sweden, Norway, Canada, Australia etc., etc., etc., learned decades ago that private health care is nothing more than rationing system based on ability to pay and enormously inefficient. They realized that a national health care system based on the principle that health care is a human right. The result across the board is lower costs AND better outcomes. The reason our healthcare system is in such a mess is because. of Reagan’s privatization, subjecting health care to the whims of corporate greed. Our system is an oligopolistic system dominated by Big Ag, Big Pharma, and behemoth hospital systems. Profit takes precedence over health and wellness. Sickness equals profits and consumers pay more and more for ever worsening outcomes. The last thing this country needs is more corporations mucking around in health care. Corporate machinations are killing the rest of us.
Quiz question 11: What are your thoughts on the clandestine back door privatization of Medicare thru the “Medicare Advantage” program? Answer; anytime you can put taxpayer money into the hands of useless corporate shakedown artists, its a win-win.
On a local note, US reps Marc Pocan (WI) and Ro Khanna (CA) recently introduced the “Save Medicare Act” . It’s simple purose, “to rename so-called “Medicare Advantage” plans, prohibit private insurers from using “Medicare” in plan titles or advertisements, and impose significant fines for any insurer that engages in this deceptive practice”. Doubt that in today’s bought off and paid for Congress (thank you SCOTUS) that even something this elementary stands a chance of getting done.
There seems to be complete Corporate Media silence on the destruction of Medicare as we know it. Dubya must be so proud!