Three Health Care Legislation Suggestions for Congress

Now that the Democratic health insurance initiatives have been neutralized, it still remains for Congress to make some progress in abating the rising costs of sick care that has taken 10% more of family income in the last 25 years, and continues to take more and more.

Some of the requirements being discussed are just plain silly. Consider these:

• As important as it is, requiring insurors to accept everyone regardless of pre-existing conditions is tantamount to bankrupting them. How can they be required to blindly take on an expense stream that is funded by much less than it costs?

• How can we “pay for” the added costs of the uninsured by reducing the Medicare expenses of our senior citizens, when the Medicare reimbursement is already below the providers’ costs. Already, the Mayo clinic in Arizona is declining Medicare patients. (Yes, it might work if the system became more efficient and less costly.)

Right now, the main driver of high costs is the fact that Americans over more than a generation have eaten too much and exercised too little, creating bodies that are incubating very expensive diseases. That works when there are few of them relative to those who can pay but don’t need the treatment, but now there are too many of them (and more and more) requiring more dollars of treatment than healthier people can afford to pay out on their behalf. That’s why we have this crisis.

Given that, here are a few steps that Congress could take fairly quickly and easily, and for which there will be Democratic, Republican and constituent support (although not from several influential lobbying groups):

1. Wellness/Fitness Involvement: Send the message that Americans have to maintain healthier lifestyles that don’t require as much expensive sick care as we do now. Do it by requiring everyone to have an annual Health Risk Assessment, and fund a case manager for everyone scoring below 60% and/or having multiple risk factors. Also, give employers a better chance to successfully incent participation in both wellness and fitness activities by expanding the legal incentive spread between participating and non-participating employees to 50% from the current legal maximum of 20%. That has been recommended to Congress. If the first seems too difficult, at least do the second.

2. Transparency and Education: Require providers to publish the most common ranges of costs for each service at the point of service so the consumer knows in advance. Also, have consumers provided with a list of questions to ask depending on the symptoms found by the doctor. Those two elements will relieve the anxiety of the consumer: They don’t know the questions to ask, and feel embarrassed to ask about cost so they can make a price/value decision. Insurors and providers will argue that the prices vary depending on the discount. This knowledge will move the market towards the lower part of the range, and drive it even lower.

3. Medical Liability: Congress doesn’t discuss it because lobbyists don’t want it discussed. The cost of liability premiums is about $2 billion a year, and drives an estimated $210 billion (of the $2.4 trillion national health care expense) in unnecessary tests, experts estimate. Provide caps for punitive damages, and limit payouts to the costs of treatment and maintenance.