No Band-Aid for health-care system

PORTSMOUTH - When it comes to controlling rising health-care costs, there is no silver bullet to save the day.

That was the repeated message heard Friday at the half-day Health Care Summit hosted by the Greater Portsmouth Chamber of Commerce.



More than 100 people attended the summit at the Sheraton Harborside Portsmouth Hotel & Conference Center, which highlighted some of the more perplexing and difficult issues faced by employers, employees, insurers and health-care providers in the state and across the country. The federal government recently estimated that health-care expenditures will rise from $1.5 trillion in 2005 to $3.6 trillion by 2014.



The consensus of many of the health-insurance experts who spoke at the conference was that there are some possible prescriptions for what ails the system. They include more data transparency and increased competition and consumer activity, as well as health-care-plan flexibility, such as health savings accounts, which are increasingly coming into play.



"The system is on the threshold of change for the better," said Nick Vailas, chief executive of Patriot Healthcare, which was recently chartered to operate in New Hampshire. The health-care system "is devoid of true competition, and we are here to start a revolution."



Vailas envisions a new approach that increases risks and rewards, and puts consumers in the driver’s seat "to go shop any aspect of health care." He used the airline industry as an example of a sector that changed with the times to better serve customers through more choice and better information.



Vailas echoed another theme of the summit - the absolute need for consumers to take more control of health-care choices in insurance, because the relatively few health-plan choices now available to businesses and their employees will escalate dramatically in the next few years.



"We really want people to make a decision," said Charles Baker, CEO of Harvard Pilgrim Health Care of New England, the state’s third-largest health insurance provider. "Many people don’t how their benefits work."



Baker used the example of his own company as one that has altered the decision-making process in how its employees choose a health plan in hopes of cutting costs.



Baker and others also called for a major leap in data transparency at all levels so health plans and their members can make better-informed decisions as to the quality and cost of the physicians and services they use.



The current system encourages a "nobody knows or nobody cares" environment, said Baker. "There is no benefit to any provider to be the lost-cost option. ... They end (up) being sort of a chump for doing it."



Anne Valette, a broker with New England Medical Insurance Agency, said the industry trend toward more "consumer-driven health care" will require consumers to be more responsible.



"They didn’t have to pay attention," Valette said regarding the true nature of health-care economics, because the once-dominant managed-care approach shielded the real costs.



A slightly dissenting view was expressed by William Schuler, president and CEO of Portsmouth Regional Hospital, and one of the few noninsurance-industry presenters at the summit. Competition, data transparency and consumer education wouldn’t make much of a difference in the current climate, said Schuler.



In particular, he warned that the "grossly unfunded" government mandates in Medicare and Medicaid distort the cost and price structures of the system. It costs hospitals such as Portsmouth Regional tens of millions of dollars annually because they must treat Medicare and Medicaid patients but are only reimbursed between 60 percent and 70 percent of the actual costs, which are then shifted to insured patients and insurance plans.



"Pricing information sounds so nice, but beware of shopping for price," Schuler cautioned, because there’s often little relation to price and cost in the health-care industry. Schuler said there needs to be an overal* federal, state and private" approach to deal with the realities of the health-care system.



"The most dangerous place isn’t a hospital that’s gone out of business. It’s one that’s losing money," said Schuler. "If we wanted to cut costs we could do it in heartbeat. ... I could close the ER and save the hospital a lot of problems."



None of the presenters or panelists at the Health Care Summit were physicians, a point brought up by Dr. Josh Siegel, an orthopedic surgeon from Exeter, who said the state was hurt by a lack of competition for services.



Dan Hussey of Portsmouth-based Global Success Solutions, a medical spa consulting firm, called for more alternative-medicine options in health-care plans.



Health care remains a major concern for chamber members, said Dick Ingram, Portsmouth chamber president.



"I was surprised by the survey saying that 92 percent know something is wrong with the system but only 35 percent believe they can do something," Ingram said. "There’s a lot more work to be done."



That was a sentiment seconded by one of the attendees, who told panelists that "the discussion (about health care) is not much further than it was 20 years ago."



The health-care debate will continue today in Concord when the Endowment for Health is expected to issue a report, "Stepping Up to the Future: A Healthier Health-Care System for New Hampshire." The report, based on the endowment’s two-year study of the state, will be unveiled at the Legislative Office Building.