Helpful resources

A tremendous amount is being written about the new health care reform law.

People have a lot of questions on what is really in the law and when things will change.  In the spirit that more information is always better than less, below are three helpful links providing information on the details of the bill.

H.R. 4872, The Health Care & Education Affordability Reconciliation Act of 2010-Section by section analysis 


Higher level summary of the bill


Implementation timeline

Why You Should Care About Health Care Reform

Health care in this country is in crisis – below we’ll take a high-level look at why this is the case.   Books can (and have) been written on the details of the situation, however by staying at a high level and not getting bogged down in details, we’ll review why the current situation is unsustainable and why this matters to each and every one of us.

One useful way to examine the problem is to separate the issues into two categories; the current state and the future state (or what’s to come).

The current state category includes issues such as:

• The number of people in the country who do not have access to adequate health care (access)
• The quality of care provided to those that have access (quality)
• Amount of money the country spends on health care given the return compared to other countries (cost)

Of course this is an oversimplification, the three issues are tied together and all have sub-issues (as we said, books have been written about the complexities).  However it gives us a way to briefly see the impact of the problem by looking at how these three areas directly impacts each of us: 

• Access –Do we want to live in a society where people die because they do not have enough money?  We each have a moral imperative to see that all individuals are guaranteed access to lifesaving treatment, regardless of their economic circumstance
• Quality – Although on an individual basis many of us are happy with our doctors, that does not mean we are necessarily getting the care we need.  Below we’ll look at the concept of unwarranted variation – how many of us are getting either not enough or too much care (controlling this would free up enough money in the system to cover everyone)
•  Cost – Even those of us with insurance are at risk of incurring costs we can’t pay.  From rising deductible and out-of-pocket costs, to our plan not covering the services we need, to the plan having benefit limits that mean it stops paying when we most need the coverage:  The current state of costs is so bad that the majority of bankruptcies in the US have medical costs as one of the contributing factors.  And as we’ll see in the next section, the precarious position we are in now is only going to get worse

The concept of “unwarranted variation” is useful in understanding some of the problems inherent in our current system.  It is defined as differences in healthcare service delivery that cannot be explained by illness, medical need, or the dictates of evidence-based medicine.   It can be caused by shortfalls in three areas:

• Effective care and patient safety – services of proven clinical effectiveness, such as using lipid lowering agents in patients with coronary artery disease not being administered to all appropriate patients
• Preference-sensitive care - treatment for conditions that have significant trade-offs in terms of risks and benefits for the patient. The choice of care should be, driven by the patient’s own preferences but this is often not the case
• Supply-sensitive care - care which is strongly correlated with healthcare system resource capacity and is generally provided in the absence of medical evidence and clinical theory.  In other words, if there are twice the number of back surgeons in a city, that city will have a higher rate of back surgeries

Unwarranted variation results in too much treatment, too little treatment and the wrong treatment.  Improving on these areas will free up a vast amount of resources that can be put to more appropriate use. 

The current system has additional causes of mistreatment including fraud and defensive medicine – both of these also utilize resources that could be better used elsewhere.

We’ve seen that for a variety of reasons, we are in the midst of a crisis.  Yet many of us don’t feel impacted by the situation, if we have insurance, are relatively healthy and don’t look too closely at the details, we may think everything is fine.  Even if this were true (which we’ve seen above is not the case) the current situation is not sustainable.

Experts use the concept of “medical trend” to talk about how the situation will change.  Among other uses, the trend number helps dictate how much insurance costs increase each year.  Medical Trend is comprised of three components:

·         Change in cost for existing services

·         Change in use of existing services

·         New services/technologies being used by the health care system

Let’s take a look at each of these individually:

Change in Costs is more than just overall inflation:

·         The medical component of the consumer price index is often used to represent this component

·         In certain populations (private insurance plans) it is also necessary to take into account negotiated rates or contracting when examining this component (a plan may negotiate a price different than the “public” price)

·         This is often considered the “least troubling” of the components – if overall medical cost changes only mirrored overall inflation rates there would not be a “cost crisis”

Change in use of existing services is due to several factors:

·         Demographic shifts - E.g. aging population – We are faced with older individuals making up a greater proportion of the population – this will increase overall costs since individuals use more services as they age

·         Changes in practice patterns - E.g. number of MRIs done - Between 2000 and 2004, the number of MRIs performed is the US rose 60% (too high to be accounted for by demographic shifts)

·         Changes in population morbidity - E.g. change in the presence of a condition that requires treatment – Over a 10 year period (1995-2005) the percent of Americans aged 45-64 with diabetes went from 6.2% to 10.2%

New Services/technologies keep coming:

·         First there were x-rays, then CAT scans, then MRIs.  New technology is constantly being introduced

·         New technology at its best represents an advance that will save more lives, but even in these cases there is a cost

·         Often these new services or technologies are add-ons, not replacement for existing ones.  That means more resources are being utilized

·         When these services and technologies are introduced, there is often a rush to use them – even if their use is not warranted

So where does this leave us? 

Each year, more resources are devoted to health care at a rate of growth that is not sustainable.  Costs have been increasing at multiples of the overall rate of inflation, leading to health care costs taking an ever increasing percentage of GDP as well as an increasing percent of government expenditures being devoted to Medicare and Medicaid.

Employers are not able to sustain their contribution levels resulting in increased premiums, deductibles and co-pays for most individuals.  As premium costs continue to rise, more and more employers will drop coverage. 

Ultimately this means that more and more of us will have to forego lifesaving care.

We are in crisis, with both a current state that is unsustainable and future trends that will only exacerbate the situation.  The only possible conclusion is that reform is needed now on multiple fronts.

While the measure currently before congress is not perfect, it is deserving of our support and puts us on the road to “curing” health care in this county.