Health Care Access, Quality and Cost?
Do We Have to Sacrifice One to Have Another?
Representative Fran Bradley
Do we have to sacrifice quality in order to save cost? Do we have to limit access if we want to improve quality and lower cost? Will higher quality automatically mean higher costs? Do higher costs ensure higher quality and access? If we limit payment for a relatively ineffective treatment are we sacrificing access and quality? What do Health Care Access, Quality and Cost really mean and how do we measure them? The answers to these and related questions are key to solving our current health care crisis.
Let me begin by giving credit to a health care system that has us all living longer and enjoying higher quality of life. Miracles in medical technology and research are largely the product of United States entrepreneurs. People come from all over the world to visit my hometown of Rochester, Minnesota, because of the Mayo Clinic and the miracles they perform. Research is on the verge of delivering an ample supply of major organs harvested from hogs. Or how about the revolutions coming with genomic research.
In Minnesota, we have among the best access in the nation with one of the lowest rates of uninsured. We have traditionally enjoyed lower health care costs and higher quality of life than virtually anywhere else in the U.S. Our employers lead the way in supporting their employees with health care benefits. Our public assisted health care programs help some 600,000 people with their health care needs. Most recently, our governor has led the charge to lower prescription drug costs by opening Canadian markets to our residents.
And yet, we just heard that health care costs, even in Minnesota, showed a double-digit increase for the fourth year in a row. Premiums, co pays and deductibles are threatening employers and employees ability to afford health insurance. The average Minnesota household pays almost $1,000 per month in total out-of-pocket health care expense. These escalating costs even threaten the global competitiveness of our products and services.
Do higher costs ensure higher quality and access? NO! In the U.S., we spend double the percentage of our gross national product (15%) than other advanced countries. And yet we rank 12th among 13 industrialized nations in 16 health indicators. Although these and other similar statistics do not tell the whole story, most researches agree that we are not getting our money's worth. Furthermore, more than 40 million Americans are without health insurance. It appears that our large investments do not buy either quality or access.
Do we have to sacrifice quality in order to save cost? NO! I spent a good deal of my IBM career focused on quality. We won a Malcolm Baldridge award and qualified for ISO certification. We turned around a company that went from the most profitable in the world to reports showing red ink. The key was quality and focus on customer. But of course, quality is delivering what the customer wants. In virtually every case, quality paid! When you do the right things and do them well, you reduce redundancy and waste; thereby improving quality while reducing cost. It really works.
Will it work in health care? Absolutely! Take, for example, the fact that less than half of people with diabetes receive what is scientifically known to be the best treatment. The result is serious, costly health problems. Just think of the savings if we could improve this to 100% (and the improvement in quality of life for the patients). Best practices, disease management, evidence-based medicine or whatever term you want to use holds great promise for improved quality and lower costs. These are not cookbook medicine - they are practice guidelines based on the latest research that could and should be a routine matter of reference. Coupled with continuous improvement processes, health care can make quantum improvements in quality while saving costs.
Are there times when quality costs? You bet! Switching to electronic medical records will improve quality of care and may eventually save money, but it requires considerable investment. Genomics holds huge promise, but the research and application will also require large investments. Procedures that cost hundreds of thousands and did not even exist just a few years ago save lives that would have otherwise been lost. Disabled people who would have died at a very young age just a generation ago now live into their senior years - at considerable expense. These are investments worth making.
How do we reduce costs without sacrificing access and quality? Doing the right things and doing them efficiently! We have already talked about how quality can actually reduce costs. It is important to note that this is all about actual costs, not the sometimes fantasy "prices" that receive so much attention in our health care system. Frankly, one of the ways to reduce costs would be to change our system of payment to a pay for value and outcomes. Even as a very cost-conscious consumer, I found it nearly impossible to understand my recent health care billing for a minor surgery. I regularly get calls from constituents upset because of the "sticker shock" they felt when billed for a health care incident. A system based on value that reduces non-value-add costs can improve quality while reducing costs.
What about access? No easy answers! Higher costs are forcing small employers to re-think their commitment to providing health insurance. Employees are facing tough choices when their premiums become unaffordable. The single greatest improvement we can make to access is to reign in health care inflation. Public assistance health care programs can fill some of the gaps for low-income people, but even the taxpayer cannot afford the bill. Charities and charity-care are also important and should be exercised to their fullest. But there is no easy answer.
What can the government do? A lot, but very carefully! About half of health care expenditures come from the taxpayers through federal (Medicare and Medicaid) and state expenditures. Minnesota has supplemented federal programs with MinnesotaCare, GAMC, Prescription Drug Program, MCHA and others. Government is also a regulator in areas such as insurance. What more can be done?
1. Pay fair rates to avoid cost shifting.
2. Eliminate wasteful regulations and mandates.
3. Provide medical malpractice relief (to also reduce defensive medicine).
4. Consolidate regulation of HMO's into Commerce.
5. Encourage and facilitate best practices, disease management, electronic medical records, consumer information, and quality assurance.
6. Fully comply with and encourage Health Savings Accounts.
7. Encourage consumer empowerment incentives and information.
8. Provide tax equity for all forms of health insurance and expenses.
The 2004 session saw historic health care policy reforms passed that build a foundation for improved cost containment. But more needs to be done.
In closing, let me reaffirm my belief in our free-market health care system. But the market must respond promptly and vigorously to our health care cost crisis.
Representative Fran Bradley
rep.fran.bradley@house.mn4316 Manor View Dr NW
Rochester, MN 55901
507-288-3439
"franbradley1@charter.net"
www.franbradley.org
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