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David A. Latif: Can we increase health-care access without raising costs?

CHARLESTON, W.Va. -- The U.S. health-care system is extremely large, includes many moving parts, and is very complex. Two key areas for patients are access and costs.

According to the Kaiser Family Foundation, three-fourths of the 49.1 million uninsured are from working families, with 61 percent of these being from families with one or more full-time worker. Many work for employers who do not subsidize health care for their employees.

Insurance coverage for a family of four in 2011 cost an average of $15,073, making it doubtful that a family earning the median income of $46,000 could pay it.

Those who do not have health insurance delay or do not get needed care until they are forced to get the most expensive care in America: from the hospital emergency room! Providing primary-care access does save the health-care system money. A recent study in the February issue of Health Affairs assessed the impact of enrolling previously uninsured patients in Richmond, Va., into a community-based health insurance program with benefits similar to the Affordable Care Act of 2010. There were significant savings, primarily because enrollees increased their use of primary care while their use of emergency services decreased. Specifically, 26,000 patients were monitored between 2000 and 2007. For people continuously enrolled for three years, costs declined by approximately 50 percent, from $8,899 per enrollee to $4,569!

The increase in health-care costs year after year must be reduced. It is unacceptable that health-care expenditures are 50 percent greater per capita than the country with the second highest health-care expenditures, Norway. There are several plausible explanations, including our fee-for-service system, malpractice insurance, technology, excessive insurance company profit, chronic health problems of many of our citizens, and the significant use of specialists. Although these must be addressed, it is unlikely that these factors fully explain the difference.

We spend at least 50 percent more than other industrialized countries, yet our health outcomes are not 50 percent better. They are average at best. How can we keep the growth of health-care costs in check, while insuring virtually all citizens? Can we really afford to spend unlimited sums on new drugs, such as Provenge for prostate cancer, that can cost $93,000 for treatment that might extend life by four months? Myriad research indicates that increased spending beyond a certain point does not improve our collective health outcomes.

According to Kotlikoff and Burns, there are seven principles regarding health care that many Americans agree on:

• Everyone needs a basic plan and should be able to purchase supplemental coverage.

• Everyone should have freedom to choose their hospitals and physicians.

• Payment for health plans should be based on income and funded through taxes and co-payments.

• Government health-care spending must be stringently capped at a percentage of gross domestic product.

• Health plans must be affordable, and those with pre-existing conditions must be covered.

• There must be incentives to prevent the overuse of health-care services.

• Medical malpractice reform is needed to limit defensive medicine.

If one analyzes the Affordable Care Act, the Ryan Medicare plan and Medicare Part C, he or she will conclude that these are all voucher programs in the sense that the voucher (payment) is handed over to the insurance company rather than the insured. So, is it really a leap of faith to conclude that we, who live in the richest country on the planet, can create a win-win situation in providing quality, affordable health care for all of our citizens without breaking the bank?

Although tough decisions and some sacrifice will be needed along the way, the alternative is far worse. I am optimistic that health care in the United States will evolve into a health-care system that covers all citizens, improves health outcomes, and does not add to our country's deficit.

Latif is professor of health-care management and chairman of pharmaceutical and administrative sciences at the University of Charleston School of Pharmacy.


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