The Joplin Globe, Joplin, MO

Opinion

March 13, 2013

Dick Thompson, guest columnist: How to lower health care costs in U.S.

U.S. health care costs are the highest in the world and growing at an unsustainable rate. March 4’s Time magazine offers 37 pages that describe why our costs are excessive and what can be done to lower them.

The good

Local health care providers, particularly hospitals and personal physicians, are among our most respected assets and institutions. We need them when we’re most vulnerable. The Joplin area medical communities did heroic work in the wake of the May 22, 2011, tornado, providing many millions of dollars’ worth of uncompensated care to the community.

The bad and the ugly

Sadly, there are big down sides to the way these favored institutions ordinarily function, and we rank below other developed nations in medical outcomes, according to our own National Research Council and Institute of Medicine.

Our health care costs increase far faster than inflation, and are now nearly 18 percent of gross domestic product. Federal health initiatives, including Medicare, Medicaid, Veterans Administration, the Department of Defense military health system (including Tricare), are largely taxpayer-supported. Costs of these systems contribute directly to our national debt.

We pay far too much for our health care and, on average, get mediocre results. Why?

Our problems

There’s decreasing local competition among health care providers. Costs to patients are rigged by both government and large providers. Major hospital systems use “list price books” — called “the chargemaster” — for services to customers who aren’t insured, cannot understand what they’re being overcharged for and have little ability to negotiate.

Medicare seems the only national insurer with enough clout to determine actual costs of services and materials to providers, and to negotiate payment based on costs. That’s good — it saves taxpayer money. Medicare provides more health care bang for the buck than any other organization, public or private.

“Not-for-profit” health care systems often make far more money than it costs to provide their services. Nationally, some small percentage of this “profit” is used to provide free community medical care. You can look up your own not-for-profit hospital’s revenue, expenses and spending for free at www.guidestar.org.

For-profit health care insurance companies, long the whipping boys for exorbitant costs and poor care, are becoming victims of the health care providers they pay on our behalf. Drug companies are insulated from price competition by Congress in Medicare Part D. Small “family doc” practices are increasingly unviable financially.

“Obamacare” provides more health care coverage to vastly more citizens and more customers to private insurance companies, but it does little to reduce the cost of products and services.

We overuse medical services and products that we can’t price and don’t pay for directly from our own pockets.

Solutions

Congress is firmly in the grip of well-funded special interest groups. Nonetheless, some solutions seem at least tenable, if we demand them from our political representatives.

We should think about health care cost reduction with a question: “What sort of society do we want to create and live in?”

If you:

• Follow Christ’s many exhortations to uplift and protect the least among us, or

• Believe in “free markets” and deficit reduction, or

• Think government has a duty to rein in monopolies and “chargemaster” excesses, or

• Believe each of us should pay graduated out-of-pocket payment for health care, or

• Think local “family docs” should be paid well and made financially viable, then:

You have strong reason to push your legislative representatives to attain your goals.

There seems no good reason we cannot have the world’s best, most cost-effective health care. To get it, we’ll have to become knowledgeable, make decisions, take action and stay engaged over the long haul. That’s a tall order. It’s much easier to be told what to do by our religious, political, media and organizational leaders.

We should strive for equitable distribution of health care costs and services to all citizens. Help fix this massive problem.

Dick Thompson, formerly of Joplin, now lives in Pittsburg, Kan.

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