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Plenty of Blame to Share for High Health Care Costs

Posted on: Thursday, 15 September 2005, 21:00 CDT

Look in a mirror and you may see a part of the reason we have high health care costs in the United States today. Regardless of whether you are a user of health care, a doctor, a hospital official, an insurance executive, an attorney, an employer or government official, this is a problem we share.

We wish we had the answer to the escalating health care costs, but we don't. The best advice we can give is to keep looking, keep talking and don't give up. And that is the advice we would offer to the 28 Bloomington-Normal specialists who are leaving the Blue Cross and Blue Shield of Illinois Preferred Provider Organization.

The doctors' departure will cause tremendous inconvenience to some of their Twin City patients -- and there is concern without a magic solution in the community. One reason for that concern is that the area's largest employer, State Farm Insurance, has been using Blue Cross/Blue Shield to process and negotiate some of its employees' claims since Jan. 1, and will be sending more that way early next year when it drops the OSF Health Plan from its coverage.

For people whose medical claims are being handled by Blue Cross and Blue Shield, the departure of 28 Twin City specialists means they will pay a higher percentage of their doctor bill, or switch to a doctor within the Blue Cross network. An unpleasant thought. An inconvenience. But patients still have a choice.

We can't blame the doctors for wanting more money if the reports are true that they are getting 55 percent or less than what they bill Blue Cross. Twin City hospitals have a little more negotiating power because of the volume of business from not only hospital care, but for care provided by the dozens of doctors who are hospital employees.

We can't be critical of Blue Cross. It just handles the claims and determines what it considers reasonable rates. Blue Cross is just a third party doing what it has been paid by employers to do -- reduce what is paid for certain procedures so the cost of insurance is held down.

Then we can go down the line to employers. They want to hold down their costs, too. Every extra dollar they pay toward employee insurance could be a dollar that can't go into salaries, so the high health care costs have an effect on payrolls.

That brings us down to us as consumers. The obvious question is whether we're making the best use of our health care services. Are we maintaining a healthier lifestyle so doctor visits are less frequent? Are we running to the doctor unnecessarily because we know, "My insurance will take care of it"?

Let's not forget the government. When Medicare and Medicaid programs pay health care providers less than their charges, those revenues are generally made up somewhere. And that usually means higher costs to private-pay patients, many of whom are covered by insurance.

And as costs increase, so do insurance premiums for both individuals and employers -- and/or the deductibles increase.

Trial attorneys enter the picture to file lawsuits when something goes wrong in health care. Huge awards for "pain and suffering" have been at least a part of increased malpractice insurance premiums. Those lawsuits have caused the best doctors to order tests that heretofore might not have been ordered. They don't want to chance being sued. And states, including Illinois just recently, have been putting caps on non-economic damages in hopes of lowering malpractice insurance costs.

We've probably forgotten some of the players in this scenario, but you get the picture.

Health care costs are a national problem in which we must all shoulder some of the blame.

Until someone finds that magic pill to level off the costs, we need to work together to discuss ways in which we can strike a balance fair to all parties involved.

Source: Pantagraph

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