Opinion

The Great Threat of Rising Health Care Costs

The Supreme Court has resolved King v. Burwell, but the Court can’t resolve the most important issue facing health care: how we as a nation can make sure the best health care is accessible to all Americans without bankrupting individuals and the country. For those of us in the health care system, that task must be our all-consuming priority.

This health care affordability crisis is not new and runs the risk of being discounted because we’ve all heard it before.  The fact that our health care system accounts for nearly 18 percent of our national spending and will only continue to increase should heighten the urgency to address the threat of even higher health care bills that affect all of us—as patients and as care givers; as employers and as employees; as taxpayers and as beneficiaries.

Many factors are driving up health care costs: specialty drug costs are rising at unsustainable rates, and in a few years, their costs alone will eclipse the total we spend today on all prescription drugs. Moreover, provider consolidation is increasing the cost of medical services for families and employers across the country.

Yet Americans have access to the most advanced health care technology, physicians, and facilities in the world.  And the reality is that we actually know a great deal about how to improve the quality of patient care. For example, we know that when patients are treated according to clinical guidelines, they generally have better health outcomes; we know that improving adherence to medication will reduce hospital readmissions; we know that certain hospital protocols will prevent the spread of infection. When we prioritize care that we know works, we also avoid costly complications in the future. So why don’t we always do those things?

Health care is not command and control.  No central actor can effectively guide all the various interactions that happen in health care and ensure better value across the board. Therefore, if we are to rein in health care cost growth, our best chance is to align all of the various actors in the system in common purpose while providing the appropriate information and transparency to facilitate good decision-making.  We need to reach a point where hospitals, physicians, employers, drug and device manufacturers, and health plans have the same interest in creating high quality outcomes at the best price.  We are moving toward a place where health care providers and health plans are in greater alignment, and we need to put more focus on how drug and device manufacturers can also effectively participate in a value-based health care system.

There is good reason to be hopeful that health care providers and health plans are finding common cause.  The American Board of Internal Medicine’s Choosing Wisely campaign helps patients and physicians ask smart questions about the appropriateness of various tests and treatments, thus improving quality and affordability.  The American Society for Clinical Oncology (ASCO) has launched an effort to better correlate price to value in cancer medicines, and notable cancer doctors are speaking out about what they see as the disconnect between drug pricing and value.  And by partnering with providers to fundamentally change the way we deliver and pay for care, health plans are leading the way to a truly patient-centered health system.

Addressing the remaining cost challenges cannot fall to any one stakeholder group or industry. Together, we all have a responsibility to improve the affordability and quality of care for all Americans. Health plans stand at the ready to work with all stakeholders to make that a reality for individuals and families across the country.

Dan Durham is the Interim CEO of America’s Health Insurance Plans (AHIP)

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