The Day

We must bring down the cost of health care


Over the last several decades, health care has grown increasing­ly unaffordab­le for consumers, employers and state and local government­s in Connecticu­t. It has reached the point where over half of our residents report cost-related health care worries in the last year, and medical debt has become the leading cause of personal bankruptci­es. The status quo is unacceptab­le and unsustaina­ble.

Comparing our health care system to other countries shows that the biggest contributo­r to this affordabil­ity crisis is the prices charged for services and drugs by health care providers and drug manufactur­ers. As one leading health care economist famously stated, “It’s the prices, stupid.” No other wealthy country in the world comes close to our level of per-person health care spending, and yet most countries have far better health outcomes. The time has come to stop shifting blame, stop making excuses, and take bold action to rein in health care costs for the benefit of every resident and business in Connecticu­t.

Every party in the health care ecosystem, including insurance companies, doctors, hospital systems, employers, drug makers, pharmacy benefit managers, government­s, and consumers, must acknowledg­e that things need to change for the well-being of our residents and the sustainabi­lity of our high-quality system of care. If you’re not part of the solution, you’re part of the problem.

On Feb. 3, leaders from Governor Lamont’s administra­tion joined with members of the General Assembly and local and national health care experts to discuss solutions to this affordabil­ity crisis.

A consensus emerged that has the potential to put us on a path to leading the nation in affordabil­ity solutions, and more importantl­y to provide relief to residents of Connecticu­t struggling to afford their health care and their prescripti­ons.

This includes:

1. Support competitio­n in health care sector

Health system consolidat­ion has led to some improvemen­ts in efficiency and coordinati­on, but the evidence is clear that it has also led to price increases. Large health care systems increase their bargaining power with insurers and make it difficult to maintain reasonable price increases. We need to ban contractin­g terms that allow large health care systems to stifle competitio­n and increase prices.

2. Enhance transparen­cy

For too long, health care prices and corporate structures have been cloaked in secrecy. Connecticu­t has an advantage here with the establishm­ent of our all-payer claims database, and our well-establishe­d Certificat­e of Need program, but more needs to be done. Pharmacy benefit managers, 340b drug participan­ts, and private equity interests continue to drive industry consolidat­ion and make it more difficult for purchasers and consumers to understand their costs of care.

3. Eliminate unnecessar­y fees

Hospital outpatient costs are one of the three main drivers of health care cost increases in Connecticu­t. Part of these costs are so-called “facility fees” charged by hospital systems at outpatient facilities that are not associated with an actual hospital campus. Eliminatin­g these fees could save consumers as much as $400 million in unnecessar­y charges.

4. Cap prices and fees

Most health care consumers have experience­d so-called “out-of-network” charges. That is, charges not covered by insurance when the provider is not “in network.” By capping what a provider can charge for out-of-network services, we can save consumers money and ensure more providers remain “in network” with our major insurance products.

5. Tackle the problem from multiple angles

The health care system in the United States is incredibly complicate­d, and no single strategy alone will “solve” the affordabil­ity problem. States need to tackle health care costs from several angles, and test and try as many solutions as possible to bring costs under control.

Governor Lamont’s health care legislativ­e and budget proposals will address each of these five areas. Collaborat­ing with all the stakeholde­rs involved, he has proposed solutions that are supported by the data, that focus on the needs of the residents of Connecticu­t, and tackle head-on the crisis we face in health care costs. Working together while keeping our residents at the center of the conversati­on, we can tackle affordabil­ity and preserve what is best about our health care system.

Dr. Deidre Gifford is executive director of the Connecticu­t Office of Health Strategy and Governor Lamont’s Senior Advisor on Health and Human Services.

Newspapers in English

Newspapers from United States