California as the United States is facing an affordability crisis when it comes to purchasing health coverage and care. Many argue that the best response to bend the cost curve that’s increasingly placing them out of reach for employers and consumers is revamping the current health care system away from the “auto mechanic” model. In that paradigm, patients are charged incrementally for each visit to the shop and “repair” they need. Reformers promote an alternative system that provides incentives for health care providers to keep people healthy and relatively free of the effects of chronic disease that account for a large majority of health care spending, particularly as people age into their senior years. If they are in less than optimal health in early adulthood and middle age, they’ll end up as very costly medical cases in future years.
“It is not possible to develop a medical system that is adequately efficient to resolve California’s affordability crisis if a large percentage of people are developing diabetes—and conditions that often come along with obesity such as depression—in their 30s and 40s,” argues Micah Weinberg of the Bay Area Council in the organization’s report released this month, Roadmap to a High-Value Health System Addressing California’s Healthcare Affordability Crisis.
“Our current food environments and the individual choices we make are creating a tidal wave of disease that our medical system cannot handle effectively and equitably,” Weinberg asserts. “Californians, therefore, must become much more engaged in improving their own health and taking personal responsibility for bringing down their own lifetime healthcare costs so that resources are preserved for those truly in need.”
Weinberg is essentially promoting a new social ethos relative to health care. One that regards health care as an expensive, finite resource and not a limitless commodity that can be easily modified to respond to consumer demand and market forces. If we as individuals over utilize health care as the result of poor lifestyle choices, that collectively incurs a major societal cost and worsens the plight of those who need care for illnesses and injuries they could not have avoided.
Cost pressures in group health coverage segment have prompted the nation’s largest employer to scale back coverage for its work force and increase employee cost sharing.
Greg Rossiter, a Wal-Mart spokesman, said the decision to deny coverage to new part-time employees resulted from the company’s revamping of its health care offerings in light of rising costs.
“Over the last few years, we’ve all seen our health care rates increase and it’s probably not a surprise that this year will be no different,” Mr. Rossiter said. “We made the difficult decision to raise rates that will affect our associates’ medical costs. The decisions made were not easy, but they strike a balance between managing costs and providing quality care and coverage.”
The full New York Times story is here.
Wal-Mart isn’t representative of the large group market given its large number of part time and low wage workers. However this development shows that rising medical costs are rapidly chipping away at the availability of employer-based coverage in the large group market just as has occurred in the small group market.
The New York Times today reports on the trend of nurses continuing their educations to obtain doctoral degrees in nursing. Physicians view the trend as another salvo in a longstanding scope of practice turf battle with nurses and some experts don’t see it doing anything to improve health care in the United States:
“Everyone’s talking about improving patients’ access to care, bending the cost curve and creating team-based care,” said Erin Fraher, an assistant professor of surgery and family medicine at the University of North Carolina School of Medicine. “Where’s the evidence that moving to doctorates in pharmacy, physical therapy and nursing achieves any of these?”
Perhaps not immediately. It will be interesting, however, to watch the role of nurses as primary caregivers evolve as more Americans gain access to medical coverage as the Patient Protection and Affordable Care Act (PPACA) continues to be phased in over the next several years. A major concern that there will be too few primary care and family physicians available to serve those who gain access to care under the PPACA. In response, there could be a major shift in medical care in which nurses become primary care providers with medical doctors serving as surgeons and specialists (as many doctors already do) treating patients with multiple complex and rare medical conditions that exceed the training and expertise of nurses.