Up next: Cost control in the healthcare challenge

As the Affordable Care Act (ACA) unfolds, more people will gain access to health services and prescriptions. The Act also reduces the risk that individuals will go bankrupt due to medical bills. Children will be able to stay on family health plans until age 26. Insurance cannot be cancelled or denied for pre-existing conditions. There is no limit on the cost or duration of medical services. Universal access is being achieved under the ACA. So what’s next?

We all need to think about how each of us can reduce the cost and improve the outcomes of our health services in ways that will improve our lives and incomes as well as those of our families, friends and co-workers.

• The cost of health insurance is based in part on your age, where you live and whether or not you are smoker. The Affordable Care Act then subsidizes the cost of insurance based on household income. One major objective is to enroll sufficient numbers of young healthy people in a relatively low-cost, subsidized insurance plan that will help spread the cost for health care across a broader number of people.
• One incentive to enroll in a health plan is a modest tax penalty. Those opting not to buy health insurance will pay a penalty of $95 or one percent of household income this year. In 2016, individuals not participating will be penalized a minimum of $695 or 2.5% of their household income per year. The average individual health insurance policy is $328 per month for the mid-tier Silver Plan.
• Though minimal essential benefits are now federally mandated, health care consumption and life styles have yet to measurably change. Though preventive care (regular check-ups and screenings) may catch early chronic diseases such as diabetes, cancer and heart disease, people’s wellness patterns and use of emergency room for treatment have lots of untapped potential.

To succeed, we all need to engage in an ongoing dialog that will achieve the objectives of access and affordability.

1) Tax penalties for being uninsured need to be either greater than the cost of insurance or at least the average of an emergency room visit. The median cost for an emergency room visit is about $2,168.

2) End of life care needs to change. A society that spends nearly 32% of life-time health care expenses during the last 24 months of life to forestall the inevitable needs to have a meaningful conversation about personal expectations and hospice care.

3) Who we see for health services and the scope of testing needs to change. Lower cost nurse practitioners and physician assistants may soon become the majority of primary care providers. In addition, remote monitoring and guidance via smart phones will add to the efficiency and timeliness of care delivery particularly in rural states like Maine and New Hampshire. A companion topic is the need for tort reform to protect providers from practicing wasteful, defensive medicine.

4) Individual health savings accounts need to be more universally adopted to encourage changes in utilization. The health cost curve is slowing but it needs to reach the norm of other industrialized nations. When it’s money from your own health savings account on the line, you tend to make cost-saving choices.

5) All medical services should be priced and rated for quality so consumers have an online standard by which to judge medical costs and outcomes. Some data is available online. In Maine, reports on procedures and a “market basket” of hospital payments are on the Maine Health Data Organization web site. In New Hampshire, NH Health Cost posts comparative data. Being an informed consumer can help lower costs without compromising quality.

6) Everyone needs to get serious about their own health and well-being to avoid the high cost of preventable chronic diseases.

With nearly 18% of the nation’s gross domestic product being spent on healthcare, we must address the causes of ill-health, the cost of health services and appropriate utilization of those services. There are no quick fixes when asking people to change, however, education and demonstrated leadership can begin to move our health system in a more sustainable direction.