Healthcare Costs Could Jump 35% Without Reform Passage

By John Ballard

Fierce Healthcare is an email newsletter for health care executives. This morning's lede links HealthLeaders Media, a leading multi-platform media company dedicated to meeting the business information needs of healthcare executives and professionals.

With the Senate Finance Committee's approval of healthcare reform legislation last week, Congress is getting closer to overhauling the American healthcare system. But what could happen if the reform efforts eventually stall and the current system remains in place?

If federal reform efforts are not enacted, the cost of failure would be "substantial"�even when looking at worst case and best case scenarios, according to a new report from the Urban Institute, which was commissioned by the Robert Wood Johnson Foundation (RWJF). The Urban Institute researchers used their Health Insurance Policy Simulation Model to estimate how coverage and cost trends would change between now and 2019 if the health system was not reformed.

"We hear a lot about the political toll of health reform, but the cost of failing to reform our healthcare system will be felt most strongly by our state governments, our communities and . . . our families and neighbors," said RWJF President Risa Lavizzo Mourey, MD, in a statement.

Among the predictions are:

? In the worst case scenario, the number of uninsured Americans would increase to 57.7 million in 2014 (from the current 47 million) and to 65.7 million in 2019. In the best case, the number of uninsured would grow to 53.1 million in 2014 and 57 million in 2019. (These estimates assume that states would continue to maintain current eligibility levels for public coverage.)

? Employer spending on premiums would increase from $429.8 billion in 2009 to $885.1 billion in 2019 in the worst case scenario, and $740.6 billion in the best case scenario.

?Individual and family spending would increase significantly�from $326.4 billion in 2009 to $548.4 billion in 2019 in the worst case scenario and to $476.2 billion in 2019 in the best case.

?Medicaid and state Children's Health Insurance Program (SCHIP) coverage would increase substantially with enrollment rising from 16.5% of the population in 2009 to 20.3% in 2019 in the worst case scenario (a 13.3% jump in the number covered under public programs). In the best case, enrollment would increase to 18.3% of the population.

?Medicaid and SCHIP spending for the non elderly would more than double from $251.2 billion in 2009 to $519.7 billion in 2019. In the best case, spending would increase by 60.7% to $403.8 billion.

?The cost of uncompensated care also would increase as much as 128% in the worst case scenario and by 72% in the best case. Together with the increased spending for Medicaid and SCHIP, this would inevitably mean higher taxes even without reform.

Questions, anyone?
Still think a bad bill is worse than none at all?
Just asking.

These people have a string of other links for further reading.

Massachusetts health execs fight global payment proposal (Links to an article in the Boston Globe),
Reform won't stop health plans from avoiding the sick, analysts say (Linking to a Washington Post article),
Doctors fight reforms cutting Medicare fees for high test, treatment volume (Links Kaiser Health News),
Study: Hospitalist physicians may cut hospital stays (Links a UPI feature).

Before closing this post, here are snips from another link for further reading.

Thinking Collectively about Health Care by Maggie Mahar

A friend who lived in France for many years once explained to me: �Healthcare is so good in France because the French believe that nothing is too good for a fellow Frenchmen.� Unfortunately, in this country, many of us do not feel that way about each other.

But I am not willing to accept the notion that Americans are �different,� so incapable of such fellow-feeling. We are, after all, in this together. As humans we are vulnerable to disease and accident. As John F. Kennedy once put it, simply by having children we give �hostages to Fate.� This is what we have in common, our common humanity. This is why the citizens of developed nations willingly pool their resources to protect each other against the hazards of fate.

?000?

The waste must be excised with a scalpel, not an axe. Individuals can make a difference. Both physicians and patients should think twice before ordering � or asking for � yet another MRI, a drug touted on TV, or angioplasty as a �quick fix� for chronic stable angina.

When a doctor recommends that you begin taking a sixth pill, a patient might ask: �Are you saying I absolutely should take this medication�or that it might be a good idea? I�m already taking five different drugs, and I�m a little concerned about becoming a walking pharmacy.� Your physician may well respond by saying �yes,� you do need this sixth pill. But the question could open up a conversation about whether you need the other five.

Similarly, before recommending routine PSA testing for prostate cancer, doctors should consider the advice of the American Cancer Society and discuss risks as well as the possible benefits of the test, giving patients an opportunity to make a informed choice.

All of us are responsible for trying to rein in needless spending, Washington can pass legislation, but change will happen on the ground if doctors step back and take a long look at their own ordering patterns.

These are some of the indications that make me think health care reform is already under way, even before actual legislation becomes final. This public debate has energized health care professionals more than anything that has happened in the last few decades. If this keeps up there is a chance that the symbiotic, incestuous, potentially corrupt and totally conflict-of-interest contaminated relationships between insurance companies, pharmaceuticals and elected representatives may possibly begin to unravel. (I politely omitted from the list double-dipping doctors invested in for-profit clinics and device manufacturers fed by their practice.)  But I'm not holding my breath.