Shadows On High: Eleven Things The Legislature Can Do To Fix Healthcare That Don

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Shadows On High: Eleven Things The Legislature Can Do To Fix Healthcare That Don't Cost Money
By Brian Rothenberg, Executive Director , Progressohio.org- Dec 19th, 2008 at 9:59 am EST 


In an era of term limits, an economic downturn, especially one of the magnitude Ohio is facing, can paralyze a legislature. But the fact remains that progressive legislation and policies cannot only be revenue neutral, they can sometimes save money. Between now and June 30 (Ohio's fiscal year end) Shadows will periodically feature revenue neutral, progressive policy ideas that can keep Ohio moving forward even in dire economic times.]

The citizens are safe: the Legislature has finally gone home. But for all the noise and headlines out of Columbus (and even Washington for that matter) things remain the same for Ohioans.

As I write, a video plays in the background announcing that one of the world's top medical institutions, the Cleveland Clinic, has just completed the first full-facial transplant. It is a breakthrough fitting for Ohio, the home of Edison, Brush, Firestone, Kettering, Glenn and so many other achievers.

But even as we march forward, our economy, in Ohio and the nation, sits in tatters. At the heart of our economic collapse is a healthcare dilemma -- a system where that world-class, pioneering care is increasingly distant from average Ohioans.

Indeed, on the very day they announced their monumental achievement, the Cleveland Clinic also announced a salary and hiring freeze because Ohio's dire economic crisis had decreased demand – in other words, people still get sick, but now they are uninsured or otherwise can't afford treatment.

Everyone is burdened by the high cost of healthcare. In fact, ProgressOhio spends 12% of its monthly expenditures on employee healthcare. Individuals are rarely spared – the rising costs are often passed on through decreased access or increased co-pays and out-of-pocket costs.

Joblessness, which Ohio is seeing record numbers of, lead to more pressures on government as the safety net of last resort in an employer paid system – hence the Cleveland Clinic's dilemma.

And central to all of this is the fact that healthcare is 15.2% of America's GDP and expected to rise to 19% by 2017. And Cleveland, one of the hardest hit of a devastated Ohio economy is heavily invested not only in manufacturing and auto products, but in medical products manufacturing and health industry sectors.

As Congress works on a comprehensive solution to America's economic collapse that will certainly include healthcare reform, we asked one of Ohio's foremost healthcare advocates, Cathy Levine of UHCAN Ohio, to help identify an agenda for Ohio's legislature that is revenue neutral and could help Ohioans control the spiraling costs of healthcare service and quality.

"Even in a tight budget, there are things we can do that don't need taxpayer money – and could actually save money," Levine wrote this week.

So here are Eleven Things Ohio Can Do to Fix Healthcare:




Increase transparency in health care spending and quality. Without transparency, we cannot figure out how to redirect current spending to improve quality and cost effectiveness.

Require insurers to report to the Ohio Department of Insurance on the percentage of premium dollars spent on health care (known as the "loss ratio"), administration, and profits, by product line. At least 15 states set a minimum for the percentage of premium dollars that insurers spend on care. This creates pressure for premium costs to go toward patient care as opposed to administrative costs or profits.
Require the Ohio Department of Insurance to hold hearings on insurance rate increases above 7% per year. This creates a check and balance pressure to hold increases down.
Direct the Ohio Department of Insurance to monitor the surpluses and reserves of health insurers and hospitals to determine the reasonableness of these amounts. This would give the state an ability to review profit reserves and encourage patient coverage spending.
Require Ohio nonprofit hospitals to report community benefit spending with the Ohio Attorney General, using fair, uniform measurements that don't count bad debt or Medicare shortfall as "community benefit." Make this report available to the public. This would create more true community service participation for underserved or under-insured Ohio patients.
Promote the use of evidence-based, unbiased information about therapeutic benefits and cost effectiveness of prescription drugs. Regulate pharmaceutical and medical device marketing to providers.

Create a pilot "academic detailing" program to provide physicians and other prescribers with evidence-based, unbiased information about the therapeutic effects and cost-effectiveness of prescription drugs, funded by either private payers, state employee plans, or settlement funds from the Attorney General. This would balance out pharmaceutical marketing practices and glamour advertising.
Prohibit pharmaceutical companies from engaging in "data mining," that is, obtaining prescribing information from providers in order to guide marketing. If you thought checking into "Joe the Plumber's" background was wrong, how about the availability of a patients prescriptions to drug marketers.
Prohibit pharmaceutical and medical device companies from making gifts to health care providers; require them to disclose payments and subsidies to providers. Simply making drug-makers disclose all contacts, gifts, meals and payments to Doctors. It's ironic that Ohio's Legislature had enough scandal to create such disclosures in politics, but leaves such laws open when it comes to drug-marketers wooing your doctor.
Improve Family Decision-Making in End-of-Life Care

Require physicians and health care organizations to provide terminally ill patients with comprehensive information and consulting about end-of-life care options, upon request. Create a public awareness campaign for End of Life Care planning.
Redirect Payments in Health Care to Desired Outcomes

Prohibit hospitals from being reimbursed by the Medicaid program for preventable errors, complications, or readmissions. Yes, that's right. An Ohio hospital that makes an error creates a complication or has to readmit a patient over a mistake or preventable error gets to send a bill to the state. It's shameful.
Create uniform billing and coding standards for all providers contracting with Medicaid, as well as health care providers and insurers. Simply stepping in and clarifying billing and coding practices can help both consumers, physicians and providers cut costs.
Formally establish a clear definition of "primary care medical home" and an accompanying set of measurable outcomes.
"We're losing jobs and our industries can't compete because of the high costs of health care, Levine said. "We can't wait for the economy to improve to start improving access, quality and affordability of health care."

That is why Washington D.C. seems poised finally to tackle the nation's healthcare problem. Even AHIP, the nation's largest insurance lobby, which fought reforms back in 1992, seems to concede the inevitability of needed reforms because of the economy's collapse. In fact, they are publicly putting forth ideas to end pre-existing condition exemptions, pool catastrophic healthcare and require coverage for all Americans (all in a way that helps their profit margin no doubt.)

A large coalition of over 30 medical professional organizations, employers, unions and progressive groups (including UHCAN Ohio and ProgressOhio) are encouraging a more comprehensive approach called Health Care for America Now that consists of a set of principles for Congress to use in crafting a comprehensive healthcare solution next year.

These straightforward principles are:

A truly inclusive and accessible health care system in which no one is left out.
A choice of a private insurance plan, including keeping the insurance you have if you like it, or a public insurance plan without a private insurer middleman that guarantees affordable coverage.
A standard for health benefits that covers what people need to keep healthy and to be treated when they are ill. Health care benefits should cover all necessary care including preventative services and treatment needed by those with serious and chronic diseases and conditions.
Health care coverage with out-of-pocket costs including premiums co-pays and deductibles that are based on a family's ability to pay for health care and without limits on payments for covered services.
Equity in health care access, treatment, research and resources to people and communities of color, resulting in the elimination of racial disparities in health outcomes and real improvement in health and life expectancy for all.
Health coverage through the largest possible pools in order to achieve affordable, quality coverage for the entire population and to share risk fairly.
A watchdog role on all plans, to assure that risk is fairly spread among all health care payers and that insurers do not turn people away, raise rates or drop coverage based on a person's health history or wrongly delay or deny care.
A choice of doctors, health providers and public and private plans, without gaps in coverage or access and a delivery system that meets the needs of at-risk populations.
Affordable and predictable health costs to businesses and employers. To the extent that employers contribute to the cost of health coverage, those payments should be related to employee wages rather than on a per-employee basis.
Effective cost controls that promote quality, lower administrative costs and long term financial sustainability, including: standard claims forms, secure electronic medical records, using the public's purchasing power to instill greater reliance on evidence-based protocols and lower drug and device prices, better management and treatment of chronic diseases and a public role in deciding where money is invested in health care.
So far, President-Elect Barak Obama has signed on to the HCAN principles as have 160 Congressmen including single-payer leaders like Rep. John Conyers as well as many Blue Dog Democrats. In Ohio, Representatives Kaptur, Sutton, Ryan, Space, Wilson and Boccieri are amongst the signatories. U.S. Senator Sherrod Brown has expressed these common themes in a letter to HCAN.

But as Congress goes through the inevitable process of reviewing proposals like HCAN and the many "Harry and Louise" moments likely in the industry led AHIP's deeply funded back pockets – Ohioans can hardly wait for some relief.

There are things the new legislature can do to not only improve health insurance services for Ohioans without having to fight over a budget.

It just takes a scalpel and a willingness to take on the insurers making the type of profits rarely seen outside the oil industry, to wrestle a little fairness and authority back into the hands of Ohio's Department of Insurance.

Ohio legislator's can ill-afford to just sit back and wait on Congress. Because the economy and healthcare costs are intertwined.