July 13, 2009 - The San Francisco Chronicle
By Paul Markovich and Priya Mathur
By Paul Markovich and Priya Mathur
As the push for national health care reform shifts into high gear, there's reason to think we may get it done this time. Here's why. Until recently, public debate over health reform seemed impossibly polarized. Deep divisions over ideology and politics spoiled the possibility for genuine dialogue and undermined willingness to forge compromises needed to enact effective health reform. At the same time, with each passing year, the squeeze on families, businesses and government finances has gotten worse. Over the last decade, health care insurance premiums have increased four times faster than workers' wages, while the average employer-paid premium for family health insurance has doubled. This relentless rise in health costs is a real drag on our economic recovery.
Still, this pain may be the most important factor driving businesses and labor unions, health care providers, public purchasers and consumer advocates to the table this year with a shared intent to reform American health care. Their motivation is reinforced by an emerging consensus about what is driving health cost inflation. America's epidemic growth of chronic diseases now accounts for 75 percent of overall health care spending. Among juveniles, there is an alarming rise in the incidence of diabetes, cardiopulmonary disease and other obesity-related diseases. According to a Rand study, more than half our national chronic disease spending is wasted. To achieve the high-performance, cost-efficient health care system Americans want, incentives must be designed that will encourage patients and health care providers to adopt best care practices based on scientific evidence.
We must also make a major national commitment to preventing chronic diseases. The World Health Organization calculates that at least 80 percent of all heart disease, stroke and Type 2 diabetes and up to 40 percent of cancer could be prevented if people ate healthier, exercised and stopped using tobacco. But today the United States spends less than 2 percent of its health care dollars on disease prevention.
Both of us participated recently in a Summit Conversation on American Health Care with a diverse group of state and national leaders sponsored by America's Agenda at the Mission Bay campus of UCSF. Based on experience in past health reform efforts, who could have expected a health plan executive to agree with national labor and business leaders that patient cost-sharing - co-payments and deductibles for pharmaceutical medications and physician treatment of chronic illness - should be eliminated entirely for patients enrolling in disease management programs, because they discourage patients from getting appropriate care? At the UCSF Summit, we agreed. Which pundit would have predicted the CEO of PhRMA (which represents major national drug manufacturers) would throw his support in with progressive California health care providers and public and private purchasers in calling for a robust national investment in disease prevention and federal, income-based subsidies for high-quality health coverage? At the UCSF Summit, it happened.
Make no mistake, the obstacles to enacting health reform this year are significant, and it will take a concerted effort by many to overcome them. Still, the unprecedented convergence of diverse voices this year gives even bruised veterans of California's past health reform efforts good reason for optimism.
Paul Markovich is the executive vice president and chief operating officer of Blue Shield of California. Priya Mathur is the chair of the Health Benefits Committee of the California Public Employees' Retirement System (CalPERS) Board of Administration.
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