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Our ‘Health Care River’

'Our Health Care River'

‘Our Health Care River’

I am both intrigued and baffled by the ongoing public dialogue that occurs about rising health insurance premiums. The recent Wellmark rate request for individual policyholders is a case in point. Last November, Wellmark requested a 12.2 percent rate increase for three blocks of their individual health insurance business, in addition to the Wellmark Farm Bureau block of business.

No one wants to see health insurance premium increases of any amount, let alone annual increases that are a multiple of the general inflation rate. However, insurance companies should not be the general villain – but they are. Why?  They represent a very easy target for many – they are large, appear to be very profitable, have nice buildings, provide generous pay to key executives, and so forth. With the naked eye, public umbrage may be understandable.

The mainstream mentality is to reform the big and bad insurance companies.  By doing so, we will have more reasonable health insurance premiums in the future…or so we think.

Now it’s time to add a good dose of reality into this discussion.

Health insurance premiums are nothing more than a derivative of health care costs. If health costs move up, so will your premiums that you pay to insurance companies. If medical costs consistently go down or become more stable, your premiums will also be favorably impacted. The true cost drivers of “Our Health Care River” fall into two general buckets:

  1. Fragmented Delivery System
  2. Unhealthy Lifestyles

Our fragmented delivery system is really not a “system,” but rather a concoction of multiple temporary or expedient remedies that attempt to solve our problems as we confront our health care needs. No one is at fault, yet we ALL are.

For decades, we have allowed our legislators (both federal and state) to cobble together laws and regulations to combat the immediate issues of the day without really understanding the repercussions of how these actions will ultimately impact long-term societal goals. We are always developing short-term solutions to long-term problems, and, by doing so, creating a fragmented delivery system that resembles more of a ‘Frankenstein’ health care system.

Unintended consequences are typically an unwanted by-product of both good and bad legislation. The consequences we have in our fragmented delivery “system” include:

  • Misalignment of payment incentives to health care providers
  • Recommended care is only delivered about 55 percent of the time
  • Little transparency in cost and medical outcomes
  • Poor coordination of care
  • Deficiencies in clinical information systems
  • Lack of accountability in care delivery
  • Medical mistakes harm about 25 percent of all patients – costly both in dollars and in lives
  • About 30 percent of all funds expended for health care are wasted

Much like chemicals in a farm field, the unintended consequences of our fragmented delivery “system” runs off into the “health care river,” causing further problems downstream. This ultimately results in higher insurance premiums, medical mistakes and, unfortunately, premature mortality.

On the other side of the ‘health care river,’ we have unhealthy lifestyles – which has been well documented. Unhealthy lifestyles include:

  • Lack of physical activity
  • Poor dietary habits
  • Smoking & alcohol consumption
  • Aging population (just a fact of life!)
  • Emotional & spiritual needs are unmet
  • Overweight and obesity issues
  • About 70 percentof the factors influencing our health are lifestyle issues

As both cost drivers flow into our health care river, the consequences become unsustainable. Trying to fix health insurance premiums downstream will first require innovative activities and solutions UPSTREAM. We all have a part to play in this new ‘system,’ a very meaningful part. This is the type of public dialogue we need to have as we continue to confront future health premium increases.

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