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The Missing Link in Ever-Rising Health Care Costs: Personal Responsibility

| February 7, 2013

Plenty can be done before getting to that point. (Sara Fasullo)

Plenty can be done before getting to that point. (Sara Fasullo)

Milissa Holland Live is on the air today, Friday, between 10 and 11 a.m. on WNZF 1550 AM, discussing the topic below. To ask questions or dial into the show, reach Holland by email here, on Facebook or on Twitter. While she’s on the air, call her at 386/206-WNZF (or 206-9693).

By Milissa Holland

Warren Buffet made one of the best proposals about the deficit in a 2011 interview on CNBC. “I could end the deficit in five minutes,” he said. “You just pass a law that says that anytime there is a deficit of more than 3 percent of GDP, all sitting members of Congress are ineligible for re-election.” The likelihood of them passing such a law is slim to none but I like the concept: accountability.

milissa holland flagler county commission flaglerlive

Milissa Holland (© FlaglerLive)

I get it. The deficit is a complex issue and it took us years to get here. But not tackling it after all these years is truly the definition of insanity, particularly when it comes to Medicare and Medicaid, the health insurance programs for the poor and elderly.

My grandfather passed away about a year ago. He grew up in the depression, served in the military, worked hard his entire life to provide for his family, and paid his taxes faithfully. He was married to my grandmother for 64 years and spent the last four years of her life taking care of her as she battled leukemia. He ended up spending the remaining years of his life in more doctors’ offices than I could count. They were both on Medicare supplemented with my grandfather’s insurance plan. I sit here wondering what he would have done without Medicare.

Yet Medicare and Medicaid spending would — if unaddressed — continue to grow at rates higher than 3 percent a year over the next 75 years. But don’t blame it all on the baby boomers. How physicians and hospitals are paid and how technology and new treatments drive costs has a lot to do with it. What can our parents or grandparents expect in the coming years when these systems are bankrupt? Why are health care costs growing so fast? As technology improves shouldn’t we see a decrease in overall costs to the system?

It’s an interesting fact that 90 percent of your health spending takes place in the last year of life. As you get older, keeping you alive is a cocktail of complexity. Organs fail. You need more specialists, more drugs, more diagnoses, just to keep you alive or to try to maintain some quality of life. An elderly patient can take up to 10 to 20 times the resources of a middle-aged adult.

And so much of the population is getting older. That’s a good thing. It’s also a very costly thing. Older people means more cancers, more Alzheimer’s cases (13.8 million forecast by 2050), more bypass surgeries, more diabetes. None of that is cheap. Technology allows us to treat more diseases, and to treat them better, but not necessarily less expensively.

Many health system reform proposals call for electronic medical records, which will help reduce costs, but mostly because the data they will generate will show which treatments are more effective. That recommended proposal is coming together slowly because very few doctors and hospitals have electronic records systems.

Samir Mehta, Ryan Nunley and others, writing on issues facing Medicaid, put it clearly: “Perhaps no governmental healthcare programs have helped as many people as Medicare and Medicaid. The Medicaid program is the third-largest source of health insurance in the United States—after employer-based coverage and Medicare. But, just as the Medicare program is facing overload with millions of baby boomers beginning to qualify, the Medicaid program—a joint venture between federal and state governments—is also under stress.”

They go on: “When seniors are eligible for dual enrollment for both, it compounds the problem. Indeed, many of the problems faced by patients and physicians in the Medicare program are exacerbated in the Medicaid population. Although the elderly and the disabled account for 25 percent of individuals enrolled in Medicaid, they are responsible for 69 percent of Medicaid spending. In contrast, children account for nearly half of those covered by Medicaid, but only benefit from 19 percent of Medicaid dollars. Economists and health policy experts agree that Medicaid and Medicare are unsustainable in their current forms, because they are growing much faster than the economy or the revenues used to finance them. With no change in existing law, the Congressional Budget Office says that the cost of Medicaid will double in 10 years and the program will account for more than 20 percent of the budget.”

So what can we do to address the issue?

Last week I addressed the issues of health and wellness, which are directly correlated to this discussion. We all take personal responsibility for the choices we make in our life, or should. When we purchase car insurance, our driving history has a direct impact on the premium cost we’re quoted. After a few years of good driving behavior we see a reduction in our cost for the service – hence saving money in our household budget.


For the users of this health care system, I just don’t see where there is an incentive to make better choices. I know through my experience on the Flagler County Commission that a lot of the users of Medicaid use our emergency rooms as if they were going to see a primary care physician. All that does is drive up the costs substantially. We know that the state’s Medicaid billing system is flawed because the state was kind enough to hand down a $450,000 bill for our residents to pay last year, after admitting to an error. No lack of responsibility there?

Considering what we know is broken, I hear very little discussion about creating a managed care system—one that educates and informs the users about choices. How many times as a parent have you made the decision to go to the pharmacy when your child is sick rather than visit the ER? I know I have because of the cost associated with that decision. If we focused our efforts on dealing with child obesity for instance (a good first step would be restoring gym class in schools) then the net effect long term would be a healthier population. One that doesn’t require thousands of tests and unlimited supply of prescription medication. It would be a more sustainable system overall.

Managed care along those lines isn’t going to solve all the issues, but it’s a good start. This week’s show on Milissa Holland Live will be a discussion on this very issue. I will be bringing the physicians and the policy makers and private insurers together for this very important topic.

I look forward to your input and questions. Tune in Friday.

Milissa Holland, a Flagler County commissioner from 2006 to 2012, is host of Milissa Holland Live on WNZF 1550 AM, Fridays at 10 a.m. Her column will appear here every Wednesday. Reach her by email here, on Facebook or on Twitter. While she’s on the air Friday morning between 10 and 11, call her at 386/206-WNZF (or 206-9693).

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10 Responses for “The Missing Link in Ever-Rising Health Care Costs: Personal Responsibility”

  1. Stevie says:

    Managed care is nothing more than the government telling me what treatment I am entitled too whether that treatment is in my best interests or not. Liberals don’t believe I am able to make my own decisions so they set up a system to take my money and send it to the government to decide for me. This is what this is and the whole country is waking up to the reality right now.

    I have already seen what managed care has done to one person. The result was death because no doctor would take medicaid for the condition and she was managed right out of her life.

  2. Diego Miller says:

    Is health care a right or a priviledge? People need to take charge of their own health and not depend on the non science of their Doctors. There are natural alternatives to prescription medicines that have no side effects. There are local farmers growing healthy organic produce and don’t forget to drink lots of ph balanced water. We must not forget the spiritual self that needs nourishment that each one of us must seek.

  3. Whodat says:

    I don’t understand why people, usually the poor, visit the emergency room for the slightest ailment they acquire. Of course, by law, hospitals can’t refuse them unless it is a private hospital. These millions of visits yearly to our emergency rooms are never paid which somehow is passed on to patients that do have insurance in some form or other as well as the overburdened tax payer.

    Why don’t these hospitals think outside the box and setup walk-in clinics in proximity to hospitals to alleviate overcrowding that places added financial and unnecessary burden on our hospital emergency rooms that will free up staff for more serious admissions. Perhaps these walk-in-clinics can be subsidized by Medicaid, donations, a percentage of the hospital bill, and supervised resident doctors in training.

    How do you temper healthcare costs to the poor without denying them access to real emergency care vis-a-vis non-emergency visits to the emergency room is the $64 question.

  4. JAMES says:

    Yes this is a major issue. I have seen first hand when it came to my parents and my aunt in their later years. Doctors would send them for test after test and medicare would pay. Even in the end the doctors wanted to preform more test and use various drugs to keep them alive but at what quality of life. Steve above is correct if you have no insurance or on medicaid no hospital or doctor wants to know you. Insurance companies charge a higher rate if your a smoker when in fact you will probably die younger and save them money in the long run. I don’t want to see anyone die but at some point we have to make a decision enough is enough there is no quality of life left. We help foreigners at no cost but if your an American with no insurance we will drive you into bankruptcy. We need major changes in our country.

  5. Nancy N. says:

    Stevie, you’re killing me blaming “liberals” for managed care. You know who invented managed care? Conservative Republicans who run insurance companies, as a way to cut their costs and make more money!

    Restoring gym class in school for kids to help make them more healthy is a great idea but no school district is going to spend their limited resources on that. Saving society as a whole money isn’t part of their mission. Raising test scores is their mission, and they are too broke to even do that. Altruism isn’t in their budget. So you’d have to give them money that was specifically designated for gym programs.

  6. Sherry Epley says:

    Excellent article on a very complex issue Milissa!

    As with almost every other major issue in our lives, there is no one “silver bullet” solution. Often it’s all too common, in our country, to be self centered and short sighted. . . and put off the work of exercise, and the fruits and vegetables we should be eating today. We want the “freedoms” of doing as we please, without the responsibility of how it effects our lives and families, much less our social programs and country as a whole. We really do want to have our cake and eat it too. . . with little or no thought regarding the far reaching consequences.

    We simply don’t realize that we can’t have it both ways. Whether we like it or not, we live on a planet where the personal choices of each one of us makes ripples out across the globe and into the future. Those ripples may be felt strongest by the healthy/unhealthy examples we set for our families and loved ones, and by the counsel we give to those who seek it. But, beyond that are choices we make in our communities. . . to stand up for what is ethical and honest, or to close our eyes in apathy. . . or blame “the government/city hall”. Unfortunately many do not really get it that “the government and city hall” is you and I. We are not governed by beings from another planet. Although, there are times when I wonder. . .Smiling!

    One way to effectively bring down health costs for everyone is to (over time) reconstruct the financial motivation of the entire health care system. Currently, doctors, hospitals and pharmaceutical companies are motivated to keep us coming back again and again for office visits, tests, and prescription drugs. This is the “fee for service” model. They make money by treating us, NOT permanently healing us. In other countries, doctors are salaried, and the price paid for prescription drugs is tightly controlled. I can tell you it is maddening to go into a pharmacy in many other countries and buy things like birth control pills “over the counter, without a prescription”, in exactly the same package as sold in the USA, for 1/4 the price!
    We are now experiencing the “down” side of capitalism. The fulfillment of our most vital needs is governed more and more by the profit motive.

    This powerful motivational force can be changed. . . the “fee for service” model is at least being questioned. . . but here again is the “big bad government” interfering. . . OR are they just folks we’ve elected trying to do the best they can to create a healthy future for our country?

    • Magnolia says:

      Sherry Eply, that “down”side of capitalism as you call it is being caused by our government, the one we have now, as well as the one before and the one before that. Government regulates the price of drugs in this country.

      If you are in the military and the government decides the medicines you need are too expensive, they stop providing them. Care is limited and you are a number. Can’t wait for what’s ahead.

  7. Stevie says:

    Stevie, you’re killing me blaming “liberals” for managed care. You know who invented managed care? Conservative Republicans who run insurance companies, as a way to cut their costs and make more money!

    Obamacare is managed care that was passed by democrats forced by the progressive liberals. You are right, the insurance companies got in bed with the government so they could profit from all this. So yes, liberals are taking my money and giving to the government to redistribute for me. They are taking your money too.

    Once you realize your body is now controlled by the collective, then we will see how well you like the health care you are told to take.

    • Nancy N. says:

      Managed care was around LONG before the ACA….private insurance companies have used it for years to cut costs in their plans. I think I had my first managed care plan when I was on my husband’s employer-sponsored insurance 15-20 years ago.

      I’m going to love the healthcare I’m “told to take.” You know why? Because right now I have NO healthcare and can’t buy it at any price because I have lupus and am self-employed. I spend more per month on healthcare than I do on my car payment and insurance, and I am still getting only a fraction of the care that I actually should be getting, even at that price. The ACA is the only way I will have a way of getting insurance until Medicare kicks in for me over two decades from now. The ACA will literally save my life. So you can take your personal freedom concerns and go cry in the corner. I’m grateful just for the freedom the ACA gives me to just live, period.

  8. elaygee says:

    Every other civilized highly developed country in the world has managed to figure out the solution by going to a single payer managed care system where everyone is covered at a fraction of the cost for drugs and services. Insurance and drug companies pay our elected officials to make sure they don;t vote for it and they spend millions more to scare the heck out of the public with made up horror stories. I have family in Israel, Canada, Australia and England and they ALL get ALL the care and medical treatment they need for a fraction of the cost we pay. And yes, you may have to wait a few weeks to get that new hip replacement but you won’t die from waiting.

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