Forum explores reforming health care

RENO - Truly effective health reform will demand that consumers play a greater role, both in taking care of their own health as well as paying attention to the money they spend on care, a panel of industry experts said in Reno Thursday.

The experts gathered in a forum organized by the Reno-Sparks Chamber of Commerce expressed doubt whether any of the reform proposals currently percolating through Congress will deliver a long-term cure to the nation's ailing health system.

And they said all three of the proposals now before the House and Senate are almost certain to bring higher taxes and fewer choices to consumers and business owners.

"It's clear that employers are going to pay," said Jim Miller, the president and chief executive officer of Renown Health.

But almost in the same breath, representatives of health-care organizations acknowledged that big changes are needed - and soon.

"It is risky to stay where we are today," said Shelly Schlenker, vice president of public policy and advocacy for Catholic Healthcare West, the parent of Saint Mary's. "The status quo is not sustainable."

Miller said the problems of the health-care system are complex and don't lend themselves to simple solutions.

Federal and state lawmakers, for instance, have proven unwilling to pay hospitals and doctors the full cost of treatment of Medicare and Medicaid patients.

That means that health providers have shifted those unpaid costs to patients with private health insurance, and insurance costs have risen at double-digit rates.

Faced with ever-higher premiums to insure their employees, employers have cut back coverage - or dropped it altogether. That, in turn, means more uninsured people seek high-cost care such as emergency room visits for routine care.

Schlenker estimated that $88 billion a year is shifted to privately insured patients nationwide as the result of the shortfall in Medicare and Medicaid payments.

Other factors that drive health costs, Miller said, include a shortage of doctors, nurses and other professionals that's only growing worse as the aging Baby Boom generation needs more medical attention.

Patients aged 65 or older - a growing segment of the American population - account for more than 30 percent of the nation's health-care spending.

With the staff shortages, salaries are rising rapidly. Pay for nurses, he said, has been rising at about 8 percent a year.

And doctors who worry about lawsuits often order unnecessary and expensive tests.

So the Renown executive said effective health-care reform will need to deal with workforce issues, tort reform and Medicare payments along with a multitude of smaller issues.

"We've got to address the core issues," Miller said.

Schlenker said Catholic Healthcare West believes that a focus on measured quality of care, including decisions about treatments that work best, also will be important to the future of the health-care industry.

"As you improve quality, you reduce costs," she said.

Dave Racer, a Minnesota author who follows the health-care industry closely, said none of the reform packages before Congress address what he believes is the key question: The need for increased involvement by consumers in their own health coverage.

As recently as 1965, Racer said, about 43 percent of all medical bills were paid out of pocket by consumers. Today, the number is closer to 12 percent.

That, he said, leaves consumers with the mistaken impression that medical care is free, or nearly free, and doesn't discipline their use of services.

Thus, he said, mothers today are quick to take children with a slight fever off to a doctor. When families paid a greater share of the cost of care, mothers often waited a couple of days before they sought care - days in which minor illnesses often disappeared on their own.

Effective reform also will require that consumers take greater control of their own health, Racer said. He said about 70 percent of health-care costs are related to lifestyle: smoking, obesity, lack of exercise.

Katie Hays, who works as a health lobbyist for the U.S. Chamber of Commerce, told the forum participants that recent polls appear to show waning support for reform measures.

Part of the reason for falling support, she said, may be concern about the costs of the plans, costs that have been estimated at $1.6 trillion over the next 10 years for the measure that's before the House of Representatives.

Racer said other potential stumbling blocks that could prevent approval of health reform range from inclusion of coverage for abortions to opposition to the so-called "public option" in coverage.