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 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

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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News Release | OSPIRG Foundation | Health Care

$80 Million In Health Insurance Waste Cut Since 2010

Since 2010, close scrutiny of health insurance rate hikes has cut over $80 million in waste and unjustified costs from health insurance premiums in Oregon, according to an OSPIRG Foundation report released today. The report also identifies changes to Oregon’s rate review program that would effectively tackle the biggest driver of costs: waste in the health care delivery system.

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Media Hit | Health Care

Public comment sought on rules for Oregon health insurance exchange

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Malpractice Legislation Nearly Ready to See Daylight

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Media Hit | Health Care

What's Next on Health Care Costs?

Now that the election is over, talk has turned to the need to work together and get results for America. It's a tall order, and on the polarized issue of health care, it may seem at first like an impossible task. But I am hopeful that we can make significant progress together.

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Report | OSPIRG Foundation | Health Care

Comments on Regence Small Business Rate Hike Proposal

We are concerned that Regence BlueCross BlueShield (Regence) has not adequately justified its proposal for a rate increase impacting 47,806 Oregonians with coverage through a small business employer.

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Report | OSPIRG Foundation | Health Care

Making the Grade

By providing better options and better information, and negotiating on behalf of its enrollees, the exchange can level the playing field for consumers.

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Report | OSPIRG Foundation | Health Care

Comments on ODS Health Plan's Proposal to Increase Rates 9.94%

ODS Health Plan (ODS) is proposing to raise rates an average of 9.94%, impacting 26,333 Oregon consumers and families with individual plans, effective November 1, 2011. The nearly 10% rate increase comes after two back-to-back years of increases exceeding 17%. If approved, the average rate will have increased 52% for individual policyholders over the last three years.

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Report | OSPIRG Foundation | Health Care

Comments on Regence Proposal to Increase Rates 22%

Regence BlueCross BlueShield of Oregon (Regence) is proposing to raise rates an average of 22.1% on individual plans. These are plans for people who do not have employer-based coverage. If approved, this rate increase will impact 59,477 Oregonians effective August 1, 2011.

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Report | OSPIRG Foundation | Health Care

Comments on Regence Proposal to Raise Small Businesses Rates

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Blog Post | Consumer Protection, Health Care

Latest Regence Health Insurance Rate Hike

Regence BlueCross BlueShield of Oregon is proposing to raise rates an average of 22% on 60,000 Oregonians. This is the fifth straight year of double-digit rate hikes. But this year, something interesting is happening.

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Blog Post | Consumer Protection, Health Care

The Oregonian and health care costs | David Rosenfeld

If you haven't seen the Oregonian's editorial on the Senate's health insurance exchange bill, it's worth a read. Unfortunately, the Oregon Senate decided to prohibit the exchange from negotiating with insurance companies to get consumers a better deal (which I'm sure insurers are happy about.)

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Blog Post | Consumer Protection, Health Care

Holding health insurers accountable for costs | David Rosenfeld

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Blog Post | Consumer Protection, Health Care

For Health Net Customers | David Rosenfeld

If you are a Health Net customer, you may have received a notice in the mail this week. If you did, we urge you to open it.

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