Health Care Reform: What's in It for Patients?

Health policy experts say consumers may not enjoy lower health care costs.

May 12, 2009— -- On the same day that insurance companies, hospitals, doctors' groups and other so-called stakeholders in the United States health care system met with President Obama to discuss reforms, 64-year-old Patty Keen of Delaware was adjusting her schedule to attend the rehearsal for her grandson's confirmation.

Some would argue that Keen, too, is a stakeholder in the U.S. health care system. Keen formerly enjoyed a career in real estate. But her battle with ovarian cancer, which began in 2006, coincided with the beginnings of the real estate slowdown -- and was complicated by her not being able to get health insurance through her employer.

Even when she was healthy, Keen had paid $450 per month to keep her private health insurance. When she fell ill, the costs of chemotherapy and prescription co-pays of up to $300 per month for each medication she needed drove her into further financial trouble. For a while, she could no longer work. In 2008, she declared bankruptcy and was forced to take a second job in order to obtain health insurance she could afford.

Today, Keen said, she considers herself an ovarian cancer survivor. But her battle on two fronts -- one against the deadly illness, the other against escalating health care costs -- left her without the home she had worked her life to buy and with bad credit.

"I basically lost everything I had to bankruptcy, because of all that had happened to me," she said. "When I couldn't work, I really couldn't pay [my insurance] -- that's what put me behind."

On the national scale, stories like Keen's are just one symptom of a health care system in crisis. But while the country's health care leaders pledged Monday to reduce the annual growth of health spending by 1.5 percentage points -- which they say will save $2 trillion in 10 years -- some health policy experts say that it is unlikely that Americans will see any of this money returning to their own pocketbooks, despite the crippling health care costs that some face.

The skepticism comes amid high hopes by others that consumers could see some relief within the next few years from crushing medical costs that, for some, have led to personal bankruptcy and other grim financial consequences.

Karen Davis, president of the health care foundation the Commonwealth Fund, said the public would likely share the trillions of dollars saved by the year 2019.

Will Health Care Savings Help Patients' Pockets?

"Administration officials calculate that this 1.5 percentage point reduction will produce an average savings of $2,500 for a family of four in the fifth year," Davis said. "This is clearly a step in the right direction."

But Ted Marmor, professor of Public Policy and Management at the Yale School of Management, called such expectations "wishful thinking."

"I think that if you were a betting person, you'd lose a lot on that bet," Marmor said. "This is utterly unrealistic."

Part of the problem, Marmor said, is that even with the 1.5 percent reduction, health costs will still be growing at a projected rate of 4.7 percent per year.

Even then, he added, the steps that the stakeholders would have to take to achieve even this reduction would require a significant deviation from the status quo.

"All of [the changes] are much harder to do than is being suggested here," Marmor said. "Customary practice is very hard to change."

John Graham, director of Health Care Studies at the Pacific Research Institute in San Francisco, Calif., had an even more pointed response to the effort.

"If the interest groups in any other American industry colluded on a plan to control costs, they'd be charged under the anti-trust laws," Graham said. "The American people should not tolerate health-care interest groups collaborating with the government to form the mother of all cartels, rationing our health care to adhere to a federal budget."

Greg Scandlen, senior fellow and director of the not-for-profit organization Consumers for Health Care Choices, agreed. "This is Big Government teaming up with Big Labor, Big Hospitals, Big Insurers, and Big Medicine to divvy up the health care pie between them," he said. "All of these interest groups have proven to be ineffective at delivering value to the American people. ... Every penny they spend comes from us, the American people, and is supposed to be used for our benefit."

What's in It for Patients?

But patients won't necessarily walk away empty-handed. The moves, if properly implemented, could mean more than just cost savings for major health care players; they could also mean that more Americans will have access to the care they need.

So said Dr. James Rohak, president-elect of the American Medical Association. Along with America's Health Insurance Plans, the Pharmaceutical Research and Manufacturers of America, the Service Employees International Union, the American Hospital Association and the Advanced Medical Technology Association, the AMA was one of the groups that met with the president on Monday.

Health Care Reform Could Improve Care

"I think that the important thing signaled for all of us by our meeting with the president today was that we want to take away the current problem that there are 50 million Americans that don't have health insurance," Rohak said. "We don't believe as physicians that the emergency room is the right way to have access to health care to do the prevention, screening and chronic health care patients need."

Judy Feder, professor of public policy at Georgetown University in Washington, D.C., and senior fellow at the think-tank Center for American Progress, said that as such efforts commence, Americans will likely see some improvements in their health care -- particularly in terms of efficiency.

"I think that immediately you will see pressure on providers to provide health care that is more efficient," Feder said, adding that there will also likely be some steps toward health coverage for every American in one form or another.

But she noted that she suspects some of the stakeholders will be resistant to change.

"They may be dug into positions in which they are not willing to accept change," she said.

Still, the pressure for the major players in the country's health care arena to work together to address the problem continues to rise.

"If we don't act soon, it is possible that healthcare expenditures will absorb 30 percent of our gross national product," said Dr. David Nash, dean of the Jefferson School of Population Health in Philadelphia. "But there is no silver bullet, no single way out."

"One thing that is clear is that if nothing is done, consumers will see much more expensive health care in the future," said Timothy Jost, professor of law at Washington and Lee University School of Law. "The [Congressional Budget Office] has projected that if we do nothing, health care costs will grow from 17 percent of GDP in 2007 to 25 percent in 2025 to 49 percent in 2082. If we do nothing, more and more Americans will also be uninsured."

Feder agreed. "What we're seeing is that nobody wins from today's system. People are left hanging, their illnesses go untreated."

Patients as Health Care Stakeholders

But just as insurance companies, pharmaceutical manufacturers, hospitals and doctors must take steps toward increasing efficiency and cost savings, health policy experts say patients, too, must make an effort to reduce their own health costs wherever possible -- and this means a healthier overall lifestyle.

Patients May Hold Health in Own Hands

"The government cannot and should not guarantee my personal health status; my employer cannot, and my physician cannot," said Jay Wolfson, professor of Public Health and Medicine at the University of South Florida in Tampa. "Only I can, for the greater part, through a combination of attentive, responsible lifestyle issues associated with diet. ... exercise, [and] personal habits."

Rohak agreed that in any plan that would benefit the health care system as a whole, the patient is a crucial part.

"We believe that if we are going to improve the health care system, the patient has to be making more informed choices than they currently are," Rohak said. "Some of the health care costs that are incurred by physicians, hospitals and insurance companies are under our control, but some of the costs are determined by the choices that patients make."

He said that the AMA is already hoping to address this need with a new Web site to help consumers address four behaviors that contribute to almost 50 percent of health care costs -- poor nutrition, physical activity, tobacco use and risky use of alcohol.

As for Keen, she is thankful that her physical health has improved, even if her financial status is still in recovery from her experience.

"My health is good now, I'm getting better, so I'm very encouraged," Keen said. "I am a survivor; I am not going to let this ruin my life.

"I lost my house, but that's OK."