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

Blog Post | Health Care

Will Oregon’s health reforms deliver results for consumers? A new study raises some tough questions. | Jesse Ellis O'Brien

According to a new study, Oregon’s efforts to transform health care are not yet delivering on their potential to improve the consumer experience.

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Blog Post | Health Care

The Whole Shebang at a Glance: Proposed Health Insurance Rates for 2016 | Jesse Ellis O'Brien

Here’s the skinny on OSPIRG Foundation’s new analysis of 2016 rates proposed by four Oregon insurers—LifeWise, Moda, PacificSource and Regence. There’s some good news, some concerning news, and some very concerning news, but the best news of all is that thanks to Oregon’s health insurance rate review process, the insurers don’t get the last word.

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Report | OSPIRG Foundation | Health Care

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

PacificSource Health Plan members with individual health insurance plans will see rate hikes of 42.7% on average, and as high as 60.4%, if the premium rate hike proposed by PacificSource goes forward. PacificSource’s increase is the largest proposed by a major health insurance carrier in Oregon’s individual market since 2010, when new rules heightening scrutiny of health insurance rates were implemented.

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Report | OSPIRG Foundation | Health Care

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

Regence BlueCross BlueShield’s membership of more than 24,000 Oregonians with individual health insurance plans will see rate hikes of 12.3% on average, if the premium rate hike proposed by Regence goes forward. Some Regence members in transitional plans that will be discontinued at the end of the current year, which do not include the consumer protections of the federal health reform law, may see increases of up to 235% if they stick with Regence.

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Report | OSPIRG Foundation | Health Care

Comments on LifeWise Health Plan of Oregon's proposal to raise individual health insurance rates

LifeWise Health Plan of Oregon’s 26,405 members with individual health insurance plans will see rate hikes of 37.2%on average, and as high as 45%, if the premium rate hike proposed by LifeWise goes forward.

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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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Media Hit | Health Care

Regence BlueCross BlueShield defends proposed rate hike at Salem hearing

Escalating medical and prescription drug costs have given Regence BlueCross BlueShield executives little choice but to raise rates an average 9.6 percent for people who buy their own insurance, an executive told Oregon insurance regulators Monday.

Jesse Ellis O'Brien of the OSPIRG Foundation said Oregonians will face less choice and more costs as a result of the proposal.

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Media Hit | Health Care

Regence Reduces Payments to Healthcare Professionals

July 26, 2012 -- Physicians and other healthcare professionals are being hit with a rate reduction from Regence BlueCross BlueShield on October 1, while the insurer is asking the Insurance Division to approve a 9.6 percent increase for roughly 53,000 people who buy their own coverage. A public hearing on that rate request will be held next Monday at 3 p.m. in Salem.

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News Release | OSPIRG Foundation | Health Care

Providence Customers May See Rates Rise As Much As 18.6%

 

More than 12,000 Oregonians with individual health insurance plans will see rate hikes of 15.7% on average, and as high as 18.6%, if the premium rate hike posted today by Providence Health Plans goes forward. Many customers will also see increased out-of-pocket costs.

 

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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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Report | OSPIRG Foundation | Health Care

Delivering on the Promise

The recently passed federal health care reform law will make significant changes in how health insurance and health care work for consumers, businesses, and local and state governments, as well as how insurers and providers operate.  But whether Americans experience improved care, lower costs and greater access depends largely on what happens next.

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