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Paying the price of future health care benefits.

Paying the Price of Future Health Care Benefits

Can we afford the future? That was the question asked by health care benefits experts recently in an atmosphere of wariness and concern at the Association of Private Pension and Welfare Plans 22nd Annual Meeting in Washington, DC.

"The health care system in the United States is wasteful and doesn't fulfill the needs of its citizens right now," said Walter B. Maher, employee benefits director for the Chrysler Corporation. "Health care bill payers, especially businesses, for the better part of the 1980s have been trying to manage escalating expenses. There have been some modest successes, but there has also been a gradual attrition of our competitiveness." He added that America is taxing and spending itself into a second-class status by "throwing away money on health care."

According to Mr. Maher, the United States spends 41 percent more than Canada, per capita, on health care--more than any other country. However, medical inflation has outstripped the Consumer Price Index during 28 of the last 30 years, and the gap is widening. "If trends continue," Mr. Maher said, "health care costs will triple by the turn of the century."

Despite massive expenditures, Mr. Maher maintained that America "isn't healthier as a nation." The country ranks 16th in life expectancy and 17th in infant mortality.

Mr. Maher blames much of the surge in health care costs on unnecessary medical care and costly technological advances. "The marketing of medicine in the United States is truly unique," he said. "We pander to the worried well in this country." As an example, Mr. Maher cited statistics for cataract operations. In 1978, 350,000 cataract operations were performed, and by 1987, the figure had leaped to approximately 1,400,000.

"Even though we are paying too much and wasting money, we attribute that to `medical inflation,'" he said. "If this was a government phenomena, we'd be up in arms about the waste."

Speaking from a congressional viewpoint, Rep. Rod Chandler (RWA) encouraged attendees to "get up in arms" and lobby legislators on important health care issues. "I can't emphasize enough how desperately we need your help," he said. "Congress is not hearing you. They tend, as a group, to be more analytical and wait for problems to be brought to them." Rep. Chandler warned that Washington is filled with "do gooders" ready to raid what benefits managers have built over the years. "I'm beginning to get real shrill on this, but you have to actively participate," he said.

Shouldering More Cost

According to Bob Patricelli, president of Value Health, Inc., the world of health care, with all its options and expenses, is far more complicated than the tools we use to combat high costs. Such tools have included networks of providers offering discounts, risk sharing and prior authorization techniques that manage the level and location of care and marketplace competition.

Mr. Patricelli believes that, on a global basis, such methods have not worked well enough. "We've achieved cost shifting, not cost containment in many areas," he said. "Particular companies or the government have played the game well and have become the net shifters instead of shiftees, but generally it has been a washout."

Mr. Patricelli maintained that employers should be prepared to shoulder a fair and proportionate share of medically necessary care without arbitrary limits. "Paying for medically necessary care is the key element," he said. "It can affect a real cost savings." He added that most benefit managers do not know that half of what is done in health care is of "unproven merit." We need a consensus on what constitutes medical necessity and a 10-year federal commitment to develop a better knowledge base about what does and does not work in health care, he said.

A Modest Proposal

Although adopting safeguards that mandate medically necessary care or calling for a federal study of health care spending seem to be worthwhile cost-cutting measures, Alain C. Enthoven, a professor at Stanford University, opts for a method that is less diffuse. Mr. Enthoven proposes that the favorable tax treatment currently afforded to employer-sponsored health benefits be limited so additional tax revenues could be raised to help subsidize the 35 million uninsured in this country.

"I just want to limit tax preference, not abolish it," he said. "We will spend as much on health care this year as we will on national defense and education combined. The current preference system is tax inefficient. Upper income people will buy health insurance to protect assets even if it isn't provided. The $11 billion that would be generated could then be targeted to less affluent people who need the benefits and possibly wouldn't buy them."

According to Mr. Enthoven, Americans would be forced to become more cost conscious consumers of health care. "It's time we give up the most expensive plans in favor of ones that offer appropriate quality care," he said.
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Copyright 1989 Gale, Cengage Learning. All rights reserved.

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Author:Johnson, Tom
Publication:Risk Management
Date:Jul 1, 1989
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