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John Benson, M.D. |
That’s what a task force co-chaired by internal medicine professors, John Benson, M.D., of UNMC and Richard O’Brien, M.D., of Creighton University, is hoping to provide the groundwork for with its recently released report on health care reform in the Cornhusker State.
Appointed by the trustees of the Nebraska Medical Association, the 21-member task force composed of physicians from across the state began meeting in January 2007 to develop a proposal with recommendations for improving health care coverage for Nebraskans.
Health insurance has become the main cause of worker strikes in the United States, Dr. Benson said, adding that the inability to keep up with rising premiums will lead to even more uninsured Nebraskans than there are today at 200,000. With health care costs increasing faster than wages and inflation, there are some troubling predictions ahead.
For example, projected numbers from the Congressional Budget Office indicate that in the year 2008, $456 billion will be spent on Medicare. Officials estimate that number will rise to $854 billion by 2017.
According to health care spending data from 2004, 18.8 percent of the state’s budget was spent on higher education while 19.8 percent was spent on Medicaid. The latter number is only expected to increase unless something is done about health care costs and delivery on a state level.
The task force opposes a single-payer federal program because of the government’s past history, its tolerance for large numbers of uninsured and its preference to fix things incrementally as opposed to comprehensively.
“Everybody’s waiting until there’s blood in the streets,” Dr. Benson said. “I’m certain that if we don’t do something now and have a plan; it’s going to cost a lot more in the future.”
Some of the task force’s recommendations include:
- Requiring all Nebraskans not covered by Medicaid or Medicare to have basic health insurance and requiring insurers to offer affordable and comprehensive basic plans, similar to those offered to federal employees;
- Subsidizing premium costs for low-income persons utilizing current Medicaid funds;
- Emphasizing public health and disease prevention through education and providing incentives for wellness programs;
- Limiting out-of-pocket expenditures (premiums, deductibles, co-payments) and subsidizing those according to annual incomes; and
- Establishing educational loan forgiveness, scholarships and bonus payment programs for providers who establish and maintain practices in underserved areas.
Much like the health plan in Oregon, where Dr. Benson is from, the task force’s plan is about rationing services rather than people, he said.
The new “public-private” plan would also only reimburse for “effective” care. A 2003 study by the RAND team found that Americans received health care that was proven to be effective only 55 percent of the time, according to guidelines from the Agency for Healthcare Research and Quality.
“That means 45 percent of the time people are not getting health care proven to be effective,” Dr. Benson said. “That’s terrible. If we reimburse only for care according to well-established guidelines in Nebraska, in the long term we would reduce costs.”
Another cost-reducing measure would stem from stipulating that all Nebraskans be covered with a basic health insurance plan.
“If you insure everybody, you do away with cost shifting,” Dr. Benson said, adding that cost-shifting amounts to $1 billion per year or 10 percent of Nebraska’s total health care expenditures.
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“If you give the uninsured money to buy insurance, doctors and hospitals should be able to reduce their fees, as they’ll no longer have to deliver unreimbursed care,” Dr. Benson said. “People will be encouraged to be healthy and won’t wait until illness gets to a more advanced stage and they won’t have to go to the ER for care as much.”
The only pitfall to the task force’s plan is its price, Dr. Benson said.
“Apparently, we’ve created a program that initially adds perhaps 5 percent overall cost while also adding to the overall health of Nebraskans,” he said, “but we plan to analyze strategies to reduce the short term added costs.”
In a tax adverse environment, the downside to spending more on health care initially is that the government either must initiate a tax or spend less on something else, such as road repair and education. But, given the steady rise in health care costs, Dr. Benson cites the, “pay me now or pay me later,” philosophy.
“We think we are reducing costs by virtue of universal coverage, investing in prevention, promoting health and wellness and healthy lifestyle education, and most importantly, reimbursing only for effective care.”
The next step, he said, is to market the health care reform report by negotiating with hospitals and legislators and speaking to focus groups at town hall meetings, with the eventual goal of letting the voters decide if the plan is a good fit for the state.
“Our hope is that we’ll be able to influence senators and the public to have a bill for the 2009 legislature,” Dr. Benson said.