Make Health Care Work Better For America

IMPROVING QUALITY WHILE CONTAINING COSTS—Health care costs too much in this country, and doesn't deliver enough based on what we pay for it. Fortunately, many of the best ways to improve the quality of our health care would also help contain costs. 

OSPIRG is calling on policymakers to go back to the drawing board and start working on solutions that will fix the fundamental problems in the American health care system. 

The bitter and contentious partisan debate in Washington is focused almost entirely on how to contain or assign the extraordinary cost of health insurance. And the specific bills being debated would likely make things worse for millions of Americans by degrading the quality of care, weakening protections for people with pre-existing conditions, and forcing many Americans to give up the coverage they currently have. 

But the biggest failure with these proposals is that they fail to address the underlying problem with the American health care system: We are spending far too much, and getting far too little in return, for our health care dollar. Despite a health care system world-renowned for developing advanced treatments, and an army of skilled and well-meaning doctors, nurses, researchers, hospital and pharmacy staff, our crazy-quilt health care system still fails to deliver an acceptable value proposition for consumers.

Health care is too expensive

Health care costs too much in this country, not because too many people have access to it, but because the system is simply too expensive. From $1,000 toothbrushes to giant price hikes for decades-old medicines like insulin, unjustifiably high costs are everywhere in the U.S. health care system.

And these excessive costs can largely be attributed to widespread waste that doesn’t actually improve quality of care — waste that is estimated to represent a third or more of every dollar we spend on health care. Fortunately, many of the best ways to improve the quality of our health care would also help contain costs.

How we can make health care work better

  • Holding the health care industry to a higher standard. America’s health care system is world-renowned for developing advanced treatments. But we often fail to get the basics right, frequently failing to provide effective, low-cost treatments that work, triggering unnecessary treatments and higher costs down the line. By expanding research into evidence-based medicine and holding providers accountable to higher standards of care, we know we can make progress.
  • Investing in prevention. Our current system rewards hospitals and doctors for performing as many procedures and prescribing as many drugs as possible, with little consideration given toward whether they actually keep us healthy and out of the hospital. We need to change those incentives, and provide easier access to preventative services. Despite some promising small-scale efforts, there’s still far too little being done to change this.
  • Holding health insurers accountable. There is often too little oversight to ensure insurance companies are delivering on their commitments to their members. In many states, insurers are not held to meaningful standards to ensure adequate access to needed services. Health insurance rate hikes receive little scrutiny even though states that review rates have cut a great deal of waste from premiums—for example, in Oregon, where OSPIRG’s advocacy for consumers has helped cut over $179 million from premiums since 2011. By focusing on insurers’ payment strategies and quantitative goals and results, closer scrutiny of health insurers can complement other efforts to drive systemic reforms to improve safety, increase care coordination, boost prevention, and bring down costs for consumers and small businesses.
  • Comprehensive prescription drug reform. America’s prescription drug development and patent system is failing consumers, too often leading to egregious price hikes or the development and marketing of the next “blockbuster” drug that may be of marginal health benefit, rather than research into needed breakthrough therapies for life-threatening conditions. The savings from overhauling the patent system—which gives pharmaceutical corporations immense pricing power—can be reinvested in research into high-priority therapies. Other commonsense reforms could also make a huge difference, like allowing Medicare to negotiate drug prices, requiring drug manufacturers to explain the basis for their prices, and stopping anti-competitive practices by big pharmaceutical corporations.
  • Price transparency for health care services. The very least we can do about rising health care costs is make sure consumers can get prices for services or treatment up front, to allow for more informed decisions about value, encourage price competition that could help keep costs in check, and create accountability for unreasonably high-cost providers.
  • Preserving competition. With countless mergers in recent years between hospital systems, health insurers, pharmaceutical corporations and others, health care has become increasingly consolidated. Unfortunately, bigger is not always better for consumers; studies show consolidation often leads to higher prices and worse service. More scrutiny of health care mergers and tougher anti-trust enforcement against companies that seek to avoid competition could make a big difference.
  • A public option health plan—e.g., providing Americans under 65 with the option of buying into Medicare or Medicaid—could provide consumers with a cheaper alternative to commercial health insurance, ensure that there are coverage options for consumers who lose their employer-based coverage or those in parts of the country where health insurers are dropping coverage, and put pressure on health insurers to provide a better deal or lose our business. 

We need your help

Powerful health care industry lobbyists will fight these changes and work to preserve the status quo, and the politics of health care has never been more divisive. But now is the time—in fact, long past the time—for our leaders to work together to advance the public interest, and address the fundamental problems of cost and quality in our health care system.

Please join us in calling on Congress to take concrete action to make health care work better for American consumers by enacting these commonsense reforms.

Photo credits, clockwise from top: Ilmicrofono Oggiono via Flickr CC by 2.0, Images Money via Flickr CC by 2.0, skeeze via Pixabay CC0 Public Domain.

Issue updates

News Release | U.S. PIRG | Public Health, Health Care

Our Statement on the Failure of the US Senate Health Care Bill

American consumers can breathe a sigh of relief today. The legislation that was narrowly defeated in the US Senate last night threatened to spark chaos in health insurance markets, raise costs, degrade quality of care, weaken protections for people with pre-existing conditions, and cause millions of Americans to lose health coverage.

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Blog Post | Health Care

A new program could cut over $81 million from Oregon health insurance premiums—but it’s at risk | Jesse Ellis O'Brien

Politicians in Salem are debating whether to refer to the ballot a new program that would contain health insurance premiums for Oregon consumers. OSPIRG runs the numbers to clarify what's at stake in this debate.

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News Release | OSPIRG Foundation | Health Care

Providence’s proposed 22.7% rate hike merits close scrutiny, underscores stakes for consumers in health reform debate

Providence Health Plan has proposed a rate hike of 22.7% on average—as high as 68.3% for some—on over 104,000 Oregonians. According to a new OSPIRG Foundation analysis released today, this rate hike proposal highlights not only the need for close scrutiny of health insurance rates, but also the high stakes for consumers in the federal health reform debate and the urgency of action to contain the rising cost of health care services.

> Keep Reading
Report | OSPIRG Foundation | Health Care

OSPIRG Foundation Comments on the Providence Health Plan Proposal for Individual Health Rates Effective January 2018

Providence Health Plan’s 104,747 members with individual health insurance plans will see rate hikes of 22.7% on average, and as high as 68.3%, if the premium rate hike proposed by Providence goes forward.

> Keep Reading
News Release | Health Care

Our Statement on Senate Health Care Bill

Statement by Jesse Ellis O’Brien, OSPIRG Health Care Advocate, on public release of the “Better Care Reconciliation Act.” 

> Keep Reading

Pages

News Release | U.S. PIRG | Public Health, Health Care

Our Statement on the Failure of the US Senate Health Care Bill

American consumers can breathe a sigh of relief today. The legislation that was narrowly defeated in the US Senate last night threatened to spark chaos in health insurance markets, raise costs, degrade quality of care, weaken protections for people with pre-existing conditions, and cause millions of Americans to lose health coverage.

> Keep Reading
News Release | OSPIRG Foundation | Health Care

Providence’s proposed 22.7% rate hike merits close scrutiny, underscores stakes for consumers in health reform debate

Providence Health Plan has proposed a rate hike of 22.7% on average—as high as 68.3% for some—on over 104,000 Oregonians. According to a new OSPIRG Foundation analysis released today, this rate hike proposal highlights not only the need for close scrutiny of health insurance rates, but also the high stakes for consumers in the federal health reform debate and the urgency of action to contain the rising cost of health care services.

> Keep Reading
News Release | Health Care

Our Statement on Senate Health Care Bill

Statement by Jesse Ellis O’Brien, OSPIRG Health Care Advocate, on public release of the “Better Care Reconciliation Act.” 

> Keep Reading
News Release | OSPIRG | Health Care

Time is running out: Oregon legislature must take action to lower Rx prices

With less than a month left to go in the 2017 legislative session, state lawmakers have so far failed to pass the Oregon Affordable Drug Prices Act (HB 2387) to prevent drug company price gouging, increase transparency and lower prices. This important bill passed the House Health Care Committee in April but has been stalled thanks to the efforts of the powerful pharmaceutical industry, whose lobbyists have been working to stop the bill. Meanwhile, prices for medications increase month after month.

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News Release | OSPIRG | Health Care

OSPIRG Applauds Passage of HB 2339

Today, the Oregon Legislature's passed of House Bill 2339, urgently needed legislation to protect Oregon consumers from large surprise medical bills. The critical consumer protection measure now heads to the desk of Gov. Kate Brown.

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Result | Health Care

Health Insurance Legislation Passed

In 2015, with OSPIRG’s strong support, the Oregon Legislature passed the state’s first comprehensive consumer protections in health insurance networks. Until now, Oregon law provided few protections to ensure that health plans offer a network that can provide covered services in a timely fashion. The new law requires insurers to provide accurate, actionable provider network information to consumers.

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Result | Health Care

Kitzhaber Administration takes action on health care costs

At the direction of Gov. Kitzhaber, the Oregon Health Policy Board has adopted an OSPIRG-backed proposal to take steps toward cutting the waste out of our health care system, estimated to make up as much as 1/3 of every dollar we spend on care.

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Result | Health Care

Governor Kitzhaber To Pursue Strengthened Scrutiny for Health Insurance Rates

Following an OSPIRG Foundation report recommending changes to Oregon's health insurance rate review process to make it more effective, Governor Kitzhaber has announced that his administration will take the next steps.

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Result | Health Care

MAKING HEALTH CARE AFFORDABLE

OSPIRG Health Care Advocate Laura Etherton helped lead efforts to require Oregon health insurers to meet tougher standards to prove premium increases are reasonable. Prompted in part by OSPIRG advocacy, Oregon officials scaled back a request by United Healthcare to raise health insurance rates by nearly 17%, saving 14,000 Oregonians a cumulative $4 million in 2011.

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Result | Health Care

Young People Now Covered

This year, the federal health care reforms that OSPIRG worked to win have started to pay off for young people. In the past, teens saw their premiums soar or were denied coverage when they turned 19, even if they’d been insured their whole lives. Now, they can remain on their parents’ plans until age 26. 

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Pages

Report | OSPIRG Foundation | Health Care

OSPIRG Foundation Comments on the Providence Health Plan Proposal for Individual Health Rates Effective January 2018

Providence Health Plan’s 104,747 members with individual health insurance plans will see rate hikes of 22.7% on average, and as high as 68.3%, if the premium rate hike proposed by Providence goes forward.

> Keep Reading
Report | OSPIRG Foundation | Health Care

Comments on Providence Health Plan's proposal to raise individual health insurance rates

Providence Health Plan’s 105,406 members with individual health insurance plans will see rate hikes of 29.6% on average, and as high as 72.3%, if the premium rate hike proposed by Providence goes forward. At the same time, the insurer is planning to scale back its service area drastically and no longer offer its plans in many regions of Oregon.

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Report | OSPIRG Foundation | Health Care

Comments on Kaiser Foundation Health Plan of the Northwest's proposal to raise individual health insurance rates

Kaiser Foundation Health Plan of the Northwest’s 26,014 members with individual health insurance plans will see rate hikes of 14.5% on average, and as high as 22.05%, if the premium rate hike proposed by Kaiser goes forward.

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Report | OSPIRG Foundation | Health Care

Comments on Regence BlueCross BlueShield's proposal to raise individual health insurance rates

Regence BlueCross BlueShield’s 14,811 members with individual health insurance plans will see rate hikes of 17.9% on average, and as high as 36.1%, if the premium rate hike proposed by Regence goes forward.

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Report | OSPIRG Foundation | Health Care

Comments on Moda Health Plan's proposal to raise individual health insurance rates

Moda Health Plan’s 58,280 members with individual health insurance plans will see rate hikes of 32.3% on average, and as high as 84.2%,if the premium rate hike proposed by Moda goes forward.

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Pages

Blog Post | Health Care

A new program could cut over $81 million from Oregon health insurance premiums—but it’s at risk | Jesse Ellis O'Brien

Politicians in Salem are debating whether to refer to the ballot a new program that would contain health insurance premiums for Oregon consumers. OSPIRG runs the numbers to clarify what's at stake in this debate.

> Keep Reading
Blog Post | Health Care

The American Health Care Act is a bad deal for Oregon | Jesse Ellis O'Brien

Congress may be about to make a historic mistake that could raise costs and degrade the quality of health care for countless Oregonians—all without seriously taking on any of the myriad problems in our health care system.

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Blog Post | Health Care

Our Statement on the American Health Care Act | Jesse Ellis O'Brien

Instead of taking on the high cost of health care and other urgent problems for consumers, Congress may be on the verge of severely damaging the nation’s health insurance markets, raising costs and degrading care for millions of Americans.

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Blog Post | Health Care

PIRG applauds decisions blocking health insurance mega-mergers | Jesse Ellis O'Brien

This week, in a big win for consumers, a district court took action to block the proposed merger between health insurance giants Anthem and Cigna. This decision follows a ruling last month that blocked the proposed merger of two more of the nation’s biggest for-profit health insurers, Aetna and Humana. These decisions come after months of work by U.S. PIRG and a broad coalition of consumer and health care groups, urging close scrutiny of the mergers from state and federal regulators and raising questions and concerns about the potential impact of the mergers.

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Blog Post | Health Care

Open enrollment for 2017: What you need to know | Jesse Ellis O'Brien

It’s that time again: Time to enroll in health insurance for 2017. Here’s our guide to Oregon’s open enrollment period, which starts November 1.

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