I have four pages of notes from today's Chamber of Commerce panel on the future adoption of President Obama's plan to reform U.S. health care, and it's hard to know where to start. I think I'll start with what the local panelists said about the problem that needs fixing.
"In a few years, health care may consume one in every five dollars spent in our economy," said Beth Giesting, the Abercrombie administration official in charge of transitioning from the current system to the one that Washington is preparing to impose on the country.
It's 16% of all economic activity today, something closer to 13% in Hawaii. Hawaii has lower Medicare costs (by far) than most states, probably due to a combination of healthier residents and the broader health care coverage that results from Hawaii's wrongly-maligned "Prepaid Health Care Act."
How fast are health care expenses growing? From 1999 to 2007, U.S. wages grew 27%. Commercial health care premiums grew 114%. And, please note, those premiums don't equal total health care costs, as you know from the ever-rising co-pays that come directly from your own wallet.
The health care industry has had good reason to grow. We're living longer thanks to miracle drugs and magnificent machines that see deep inside our organs. These things cost money. We're spending more hours working, usually while sitting, raising U.S. productivity, but at cost to our health, and this, too, costs money. We're living longer, which means more years of doctor visits, and this costs money also.
But medical costs are also growing for bad reasons. While Medicare has 3% administrative costs, health care plans nationwide average 13% administrative costs. Maybe Medicare is spending too little on administration, but I'll bet you have a very different explanation. Giesting must agree with you, becayuse she says America pays twice as much as the average industrial nation on health care without actually getting a particular good quality of care.
"Any additional amount of money spent on health care is money that an employer can't spent on salaries, expansion, or research and development," Giesting said.
Our nation of 330 million people has 50 million insured. Three people on this panel of eight people said they grew up uninsured. One of them was Dr. Tom Tsang, senior advisor to Gov. Abercrombie on health matters. Tsang, born in Hong Kong but raised in New York by parents who had a Chinese restaurant, says his octogenarian parents have several chronic health problems and each takes more than a dozen different medicines a day.
"How many of their health problems could have been spotted, and treated, less expensively, years ago, if they only had medical insurance back then?" he asked.
When someone is uninsured, three things can happen:
- They get sick, and go to the emergency room, the single most expensive way anything can be dealt with, and the cost, not paid by them, is shifted to everyone else.
- They stay well, and "get away with it," but because they and their employer are not paying premiums, the cost of health care rises for everyone else.
- They develop chronic conditions that can be treated later, but at much greater cost, then if the problems were spotted in early stages. This is what Tsang is referring to.
Until today, I thought most uninsured fell in the second column, mostly getting away with it but not paying their fair share of premiums. But Tsang says that may have changed, now that so many young people are sedentary, obese, and are getting problems we used to associate with middle age. That would put them more into the third category, the one the doctor is talking about.
Obamacare aims to get more people insured and care for, while embracing cost savings that were already being tried across the country, including here, like electronic patient records, a greater focus on preventive care, and new ways of paying doctors and hospitals that reward cures, penalize readmissions, and tie less compensation to the number of tests and procedures ordered.
The state has a group already at work to develop an online portal for health care insurance comparison shopping. Joan Danieley of Kaiser Hawaii repeatedly compared it to Travelocity. The interim board should have systems, procedures, and the Web site ready to show in one year. Jennifer Diesman of HMSA says the online exchange will be called the Hawaii Health Connector.
Attorney John Knorek says there will likely be some tweaking of the national plan before it really kicks in, probably in 2014. Knorek has spotted one potential issue: the law expressly allows the Hawaii health care law to remain in force, but at one point refers to its original version. Well, the original version had a sunset provision that the state legislature later repealed. This could be a Catch 22 if not resolved. Knorek also explained how, in some cases, a company might find it more expensive to offer coverage to employees than to not do so and simply pay the fines.
Jennifer Sabas, chief of staff to Sen. Dan Inouye, offered an intriguing comment about the politics of the health care plan. Offered an opportunity to discuss the attempts to change the plan on Capitol Hill, she remarked that there might be further changes to the plan but she felt all sides knew at this point that the plan will not be repealed.
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