California coalition’s report calls for overhaul to rein in health care costs – Health and Medicine – The Sacramento Bee
Simply put, participants said Californians should “collectively” create a health culture.
A critical part of this involves creating environments where people are eating healthier foods in smaller portions and getting exercise, especially walking.
“We need to reduce the burden of illness on the health care system,” said Shortell. “It’s important that we design communities and schools to increase and encourage physical activity.
I would add that how people work should not be overlooked as it was in the Berkeley Forum report. We should rethink how knowledge work is done in the 21st Century and develop more modern ways of performing it rather than adhering to the outmoded 20th Century paradigm of sitting in a commute to go sit another 8 hours in a centralized office.
Is the sedendary commuter/cubicle treadmill that also wastes time that could be spent engaged in sustained exercise really worth the price to our health? I say it is not, especially when most information and knowledge work can be accomplished outside of a central office location. If Californians are properly to be expected to take more responsibility for their health status and prevention, they must also be afforded the fullest possible degree of freedom and time to exercise — literally– that responsibility.
The Bay State does another first in health care reform. First with a state-based health insurance exchange and a mandate that everyone have health coverage. Now the first state to attempt to bend the health care cost curve by force of law, albeit a paper tiger according to the story.
Here’s an excerpt from the story by WBUR and Kaiser Health News:
Under the new law, hospitals and doctors will have to cut their rate of cost growth about in half. So, instead of going up 6 to 8 percent per year, costs would only be allowed to rise 3.6 percent per year.
“No other state has tried to tie health care costs to the state’s economy,” said Massachusetts Association of Health Plans President Lora Pellegrini. “This is going to be really revolutionary and very important and I’m sure the nation’s watching.”
Michael Widmer, with the Massachusetts Taxpayers Foundation, says he thinks the health care industry will embrace the bill’s spending goals, even though they are what he considers aggressive.
“But on the other hand the legislation does not include triggers or punishments if the targets aren’t met,” he said.
In today’s business world, there are plenty of things to be sick about. Urgent deadlines (even when some aren’t urgent), constant interruptions (how many times do you need to hear about Steve’s weekend?!), way too many meetings, endless politics that waste precious energy that could be aimed at the actual work – not to mention an all-around lack of sleep. These reasons, and so many more, can lead to workers who are just plain miserable.
So when we say that the workplace is full of “healthcare” issues, we mean a bit more than benefits. The health of any office is tied to a number of factors beyond the doctor’s office, and it would seem that even the best insurance plans can’t protect against the evils of limited vacation time or long commutes.
ROWE presents a true workplace wellness program that can get real results, reducing health care utilization. It goes beyond gym membership subsidies (not beneficial if people don’t have time to go there) and symbolic gestures like award certificates for serving healthy snacks at meetings.
Last week’s Supreme Court decision on the constitutionality of the Patient Protection and Affordable Care Act (PPACA) and specifically the so-called individual mandate turned on the penalty for not having minimum essential coverage under Section 1501 of the PPACA. While the court ruled the government cannot compel all Americans have health coverage, the government may require payment of a penalty for not having it as a permissible exercise of Congress’s power to levy taxes. The penalty gives the mandate real teeth. Without it, the mandate would be a paper tiger.
The individual mandate in turn is designed to work with upfront tax credits to subsidize the cost of coverage for those who earn above 133 percent of the federal poverty level and are thus ineligible for Medicaid. The penalty for not having coverage is the disincentive or stick and the tax subsidy to defray plan premiums or fees is the incentive — the carrot. Insurers and health plans also have a mandate to sell coverage to whoever is willing to buy it starting in January 2014 regardless of their medical condition.
Together, the carrot and stick built into the individual mandate along with the requirement insurers and health plans accept all applicants (per sections 2701 and 2704 of the Act) is intended to save the individual and small group health insurance market segments from the black hole of adverse selection and ultimately market failure. The acceleration in adverse selection in recent years occurred in the individual market due to increasingly selective medical underwriting standards in states where payers are permitted to screen out people likely to incur high medical treatment costs. Adverse selection also threatens the viability of the small group market due to poor spread of risk among employers of 50 or fewer employees— and particularly numerous micro businesses with five or fewer workers.
In order to preserve these market segments and to also reduce rising premiums in the large group market due to the shifting of medical treatment costs incurred by those without coverage to the insured population, the PPACA has created an alternative and far more compulsory health insurance market than existed prior to its enactment in early 2010. Daniel Weintraub, a veteran Sacramento print journalist with deep knowledge of the health care market, described the new market landscape that will fully emerge in 2014 as one in which insurers and managed care plans will effectively become a “quasi-public utility.”
The question going forward is whether this government-drawn and enforced market can achieve sufficient savings and spread of risk to ward off market failure in the individual and small group market segments. In addition, given that health insurance functions as a pass through mechanism, whether the chronic disease prevention provisions of Title IV of the PPACA will meaningfully slow the relentless rise in medical costs driving up premiums.
The Sacramento Bee reports today the California Public Employees’ Retirement System will boost health insurance premiums next year for its 1.3 million public workers and retirees that pencils out at 9.5 percent and represents “one of the biggest increases in years for CalPERS,” which is one of the largest purchasers of the health care in the nation. As such, CalPERS health insurance costs serve as a closely watched barometer of where health coverage costs are headed.
A major contributing factor to the health insurance crisis is an epidemic of obesity that’s boosting the health care spend and accounting nearly a quarter of health care costs. A Cornell University study published in the January issue of the Journal of Health Economics estimates obese patients incur medical costs that are $2,741 higher in 2005 dollars than if they were not obese. Nationwide, that translates into $190.2 billion per year, or 20.6 percent of national health expenditures, according to the research, which notes earlier estimates measured the cost of obesity at $85.7 billion, or 9.1 percent of national health expenditures.
While a major driver of health care spending, obesity is merely a distressing symptom of a larger dysfunctional set of American cultural economic and lifestyle choices that drive up health care utilization. They include poor work-life balance (long workweeks, long commutes to obsolete office spaces and associated stress), lack of exercise (and sufficient time for sustained daily exercise), too little sleep, unhealthy diets (and their commercialization via the “foodie” culture) and the expectation that health issues can be “repaired” by medical treatment and the state of the art pharmaceuticals.
In an information intensive economy, those who create, process, analyze and add value to information can do so from anywhere thanks to the proliferation of Information and Communications Technology (ICT) over the past two decades. Yet paradoxically, many Americans still engage in a daily commute to the office as if it were the 1950s of Dagwood Bumstead or the 1980s that inspired the more modern day office place comic strip, Dilbert. In those days, commuting to the office was necessary because that’s where the office equipment was — telephones, typewriters (and later, dedicated word processors), photocopiers and fax machines. Not anymore. Today, nearly any setting can function as an office where a knowledge worker can concentrate and be productive.
Nevertheless, on average Americans spend nearly an hour a day getting to and from an office that ICT has effectively rendered obsolete. That adds up to a lot of wasted and often stress filled time piled on top of an increasingly sedentary culture that battles the rising health care costs of lifestyle-induced chronic conditions linked to a lack of exercise, poor diet, and inadequate sleep. For the time crunched trying to balance family obligations with work, avoiding these adverse health impacts is even more challenging. Just look around any traditional office setting and chances are you’ll see plenty of stressed out, sleep deprived, and overweight people who are more likely use medical services and in turn increase their employers’ health care utilization costs.
What’s needed is a new model for traditional office-based work that can free up time for exercise, healthier home cooked meals and sleep that would otherwise be wasted on daily commuting. Fortunately, such a model better suited to today’s highly connected, information everywhere economy exists: ROWE or a Results Only Work Environment. A ROWE values getting the work done over daily office attendance. Early indications are that workplaces that adopt ROWE can achieve better health status at a time when workplace wellness is getting increased attention to slow the nation’s unsustainable rise in health care costs. A University of Minnesota study issued in December 2011 found workers in a ROWE realized increased health-related behaviors of more sleep and exercise — behaviors that can go a long way toward maintaining health and reducing medical utilization. ROWE is poised to become the successor to traditional “workplace wellness” programs that have been slow to demonstrate tangible progress in reducing employer health care costs.