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 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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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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Media Hit | Health Care

Public comment sought on rules for Oregon health insurance exchange

State officials are holding a hearing Wednesday to receive public comment on rules for the state's health insurance exchange -- essentially an online marketplace for consumers called for by federal health reforms.

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Media Hit | Health Care

Malpractice Legislation Nearly Ready to See Daylight

After months of negotiations between trial lawyers and physicians, legislators are optimistic about reaching a consensus on medical malpractice reform when they gather in Salem next month. All along the goal has been to find a way of reducing lawsuits while creating a safer patient environment.

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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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News Release | OSPIRG Foundation | Health Care

Regence rate hike scaled back

State officials have decided to trim Regence BlueCross BlueShield of Oregon’s proposal to raise rates for more than 52,000 Oregonians with individual health insurance plans. Instead of the 9.6% rate hike proposed, the Oregon Insurance Division approved an 8.9% average increase, with some consumers seeing increases as high as 15.6%. Regence does not appear to have resolved many of the problems identified in OSPIRG Foundation's analysis of their proposal. In addition, elements of the decision were based on information that was not made available to the public.

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News Release | OSPIRG Foundation | Health Care

Regence Rate Hike Not Justified

Regence BlueCross BlueShield of Oregon’s proposal to raise rates for Oregonians with individual health insurance plans does not measure up, according to a new OSPIRG Foundation analysis.

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Report | OSPIRG Foundation | Health Care

Comments on Regence Proposal to Raise Small Businesses Rates

Regence Blue Cross Blue Shield (Regence) is proposing a rate increase on small business plans, with an average increase of 10.8%, impacting 54,299 Oregonians, effective July 1, 2011.

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Report | OSPIRG Foundation | Health Care

Building a Better Health Care Marketplace: Negotiating for a Better Deal

A well-made state exchange can help deliver lower costs for individuals and small businesses. Just as big businesses negotiate with insurers, using the bargaining power of their employees to push for lower premiums, so too can exchange enrollees benefit from a muscular exchange that negotiates on their behalf for better choices and lower costs.

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Report | OSPIRG Foundation | Health Care

Building a Better Health Care Marketplace: Ensuring Accountability

The creation of a new health insurance exchange offers states an opportunity to improve health care and lower costs by pooling consumers’ bargaining power, creating economies of scale, and pushing insurers toward delivering lower costs and higher quality.

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Report | OSPIRG Foundation | Health Care

Comments on Health Net's Rate Increase Proposal

Health Net Health Plan of Oregon is proposing an average 8.27% rate increase on small business plans impacting 37,872 Oregonians, effective April 1, 2011.

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Report | OSPIRG Foundation | Health Care

Comments on United HealthCare's Proposed Rate Hike

In this rate filing, United HealthCare does not appear to justify the proposed 16.8% increase.

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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

What if health insurance companies had to stand before the public and clearly justify their rate hikes?

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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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