Controlling health costs will test us whatever the Supreme Court decides.
The U.S. Supreme Court ruling on the Affordable Care Act (ACA), Obamacare, won't be -- and shouldn't be -- the last word on health reform. Setting aside the hyperbolic rhetoric on what the legislation does and doesn't do, there remain good reasons to both support and oppose ACA.
In fact, the two of us don't see eye-to-eye on the legislation. One of us believes that the bill was the best that could be achieved under the circumstances and that providing coverage to an additional 30 million Americans, as ACA will do, starts the long-overdue journey to comprehensive health reform. The other sees ACA as a worrisome expansion of federal control and coverage without corresponding (and necessary) controls on costs.
However, despite our differences on ACA, both of us do agree that with or without ACA the soaring cost of health care will undermine the private health care marketplace and crowd out other important public priorities. In fact, the Minnesota Department of Health reports that in the next decade, health spending in Minnesota will double -- and that doesn't even include the rising cost of long-term care (not a comforting prediction in a rapidly graying state).
We also agree that, whatever the Supreme Court decides, the delivery and financing of health care need to change in fundamental ways.
Start with the current financial incentives. Today, doctors, hospitals and other providers typically are compensated for every service they provide, not for improving the patient's health. That has to change. New payment systems are needed to reward caregivers on the basis of outcomes, not procedures.
One barrier to meeting this goal is the fragmentation of health care delivery. A primary care physician, specialist and hospital may be treating the same patient, but with little awareness of what the others are doing. Some Minnesota health systems are among the nation's leaders in developing new ways to coordinate care. That's especially important for managing the costs incurred by the 10 percent of patients -- mostly those with chronic diseases -- who consume nearly two-thirds of all health dollars.
The role of consumerism in cost control also deserves scrutiny. There is a difference between having "skin-in-the-game" and simply being skinned. Today's "consumer-directed" health plans mostly call on individuals to pay more for health care through higher insurance premiums and deductibles. But that alone doesn't make us smarter consumers.
To be better buyers of health care we need better information, especially at decision-making time. Websites, quality ratings and other tools are useful, but nothing beats the ability to talk directly to a doctor or nurse about a specific procedure, especially if the patient knows enough to ask the right questions and the care provider is paid for the time to have the conversation.
Patients also ought to be financially rewarded for making decisions that are cost-efficient and keep them healthy. They should share some of the savings, not just avoid financial penalties like higher co-pays or out-of-pocket expenses.
Another factor is tort reform. Eliminating unnecessary lawsuits would reduce malpractice premiums and encourage doctors and hospitals to practice less "defensive medicine" in which more tests and procedures are ordered to protect against lawsuits.
Reform must also focus on prevention. Certainly, it's up to us to make smart choices about diet, smoking and exercise -- and an argument can be made that insurance rates should reflect some of those risks. It is also reasonable that public policy should reward good health practices.
In addition, treatments need to be based on what works, not on where we live. A Dartmouth Atlas Report found huge variations in care based solely on geography, not health outcomes. That adds unnecessary cost to the system. Better data would help guide more effective treatments.
These are challenging issues with no easy answers. We acknowledge that these proposed reforms will be just as controversial as ACA. But, if ACA is struck down, the challenge of expanding access to health care doesn't go away. And if ACA is upheld, costs still have to be controlled.
So, whatever the court rules, health reform must stay in front of us and our elected leaders until we fix our broken health care system by better controlling costs -- while assuring greater access.
Tom Horner is a public-affairs consultant and was chief of staff to former U.S. Sen. Dave Durenberger, R-Minn. Tim Penny is president and CEO of the Southern Minnesota Initiative Foundation and is a former Democratic member of Congress. Both are former Independence Party candidates for governor.