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

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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Report | OSPIRG Foundation | Health Care

Comments on PacificSource Health Plans' proposal to raise individual health insurance rates

PacificSource Health Plans’ members with individual health insurance plans will see rate hikes of 15.2% on average, and as high as 25%, if the premium rate hike proposed by PacificSource 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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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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Media Hit | Health Care

Hooray! Few Oregonians receive health insurance rebates

As health insurance companies spread $500 million in rebates to families around the U.S. this summer, Oregonians won’t represent a huge chunk of the recipients. That’s a good thing, argues Jesse Ellis O’Brien, health care advocate at the Oregon State Public Interest Research Group (OSPIRG).

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Media Hit | Health Care

Oregonians pay on average 10 times more for top-selling brand name drugs

Oregonians have paid on average 10 times more for top-selling prescription drugs because of deals between drug manufacturers to delay production of generics. The 20 top prescription drugs that paid off their rivals to keep generics off the market resulted in average delays of five years that left patients paying up to 33 times as much for brand names, according to a report released Thursday from the Oregon State Public Interest Research Group and Community Catalyst.

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News Release | OSPIRG | Health Care

Twenty Top Generic Drugs Delayed By Industry Payoffs

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Media Hit | Health Care

Oregon slashes 2014 health insurance premium requests by as much as 35 percent

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Media Hit | Health Care

OSPIRG: 16 Health Insurance Companies Need To Justify Rates

An Oregon consumer group says the 16 companies that have proposed insurance rates for the state's new health exchange haven't offered adequate justification for prices.

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Report | OSPIRG | Health Care

Top 20 Pay-For-Delay Drugs

Too often, consumers are forced to shoulder a heavy financial burden, or even go without needed medicine, due to the high cost of brand-name drugs. Our research indicates that one significant cause is the practice called “pay for delay,” which inflates the drug prices paid by tens of millions of Americans.

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Report | OSPIRG Foundation | Health Care

Comment on Providence Health Plan's Proposed Individual Health Insurance Rates

Providence Health Plan has proposed premium rates for its individual and family plans for 2014. The insurer initially filed for significantly higher rates than Oregon’s other top insurance companies,   but then proposed lowering the rates. Doing so would bring the rates in line with those of competing insurers. OSPIRG Foundation's analysis of Providence's initial filing and the supplemental information provided raises some concerns about the insurer's proposal and its justification.

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Report | OSPIRG Foundation | Health Care

Comment on Kaiser Foundation Health Plan's Proposed Individual Health Insurance Rates

Kaiser Foundation Health Plan of the Northwest has proposed premium rates for its individual and family plans for 2014. Since its initial rate filing, the insurer has submitted a proposal to reduce those rates. OSPIRG Foundation's analysis of Kaiser’s initial filing and the supplemental information provided raises some concerns about the insurer's proposal and its justification.

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Report | OSPIRG Foundation | Health Care

Comment on BridgeSpan Health Company's Proposed Individual Health Insurance Rates

BridgeSpan Health Company—a new health insurer affiliated with Regence BlueCross BlueShield of Oregon through a parent company, Cambia Health Solutions—has proposed premium rates for its individual and family plans for 2014. OSPIRG Foundation's analysis raises questions about the insurer's justification for the proposal, and about BridgeSpan's efforts to reduce costs by cutting waste and focusing on prevention.

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Report | OSPIRG Foundation | Health Care

Comments on LifeWise Health Plan's Proposal for Individual Health Insurance Rates

LifeWise Health Plan of Oregon has proposed premium rates for its individual and family plans for 2014. After careful analysis of LifeWise’s initial filing and the supplemental information provided, OSPIRG Foundation's analysis questions whether the insurer has provided sufficient information to evaluate the justification for their proposed rate.

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Blog Post | Health Care

Few Oregonians will receive health insurance rebate checks this year—Here’s why that’s a good thing | Jesse Ellis O'Brien

This summer, consumers and businesses nationwide will receive $500 million in rebates from health insurance companies. Only 1 in every 200 Oregonians will see a dime as a result of this program, and that’s great news for our state. Here’s why.

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Blog Post | Health Care

Competition and Transparency Bring Down Health Insurance Costs—Here’s the Proof | Jesse Ellis O'Brien

Something remarkable just happened to health insurance costs here in Oregon. Last week, after the state’s health insurers posted their proposed premium rates for next year, two insurers publicly reversed course and moved to cut their prices.

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Blog Post | Health Care

The Supreme Court and the High Cost of Rx Drugs | Jesse Ellis O'Brien

Everyone knows prescription drugs cost more than they should. But many people are surprised to learn about one of the key ways drug companies keep prices high: Paying off competitors to keep generics off the market.

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Blog Post | Health Care

A new way of shopping for health insurance gets a trial run | Jesse Ellis O'Brien

 

For the first time, the Oregon Health Insurance Exchange brought in consumers and outside experts to review their designs for their online marketplace. I was there, and here’s some of what I learned.

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Blog Post | Health Care

Here’s that Rx refill you didn’t order | Jesse Ellis O'Brien

Is your pharmacy refilling your prescription without your knowledge or approval, and billing your insurance company for the cost? If so, it’s the latest example of waste we shouldn't tolerate in our health care system.

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