Health-care reform runs in circles

Despite the sincere effort being made, health-care reform in Utah and nationwide is destined to run in circles unless everyone gets serious about medical costs and affordability, members of a special legislative task force were told Friday.

Reformers are stuck in a rut of parsing out what's unaffordable: Medical care will equal the average Utah household's income in less than 10 years; Medicaid coverage for poor Utahns is on a track to equal the entire state budget in about 15 years, task force members were told.

"The attitude has been that somehow tweaking the insurance mechanisms on one side and delivery mechanisms on the other, we're going to rescue health care," said Douglas Emery, a health-care reform consultant who has developed a new consumer-driven economic model for medical care. "That's why we keep going in circles. Price, cost and outcomes in health care are independent of insurance, which by its very nature will blur each one of those factors."

Emery called for a "radical restructuring" of incentives in health care, such as rewarding wellness and health improvement, not the number of medical procedures rendered. The approach has been defied by the "current brick-and-mortar genetics of the current system," he said.

Making the system transparent is key to revealing the cost of care, which continues to rise at double-digit inflation and with no end in sight, he said.

Emory and others said the result is a rat's nest of complicating factors in which providers can't or won't supply the actual costs, and insurance companies are reluctant to continue to underwrite plans, particularly for individuals without insurance, because the only thing known about costs at this stage is that they will continue to increase.

Combing through some of the tangles was addressed in part Friday by a proposal offered by the task force's insurance review work group. It has drafted a set of steps called NetCare to expand insurance coverage for individuals who are uninsured or are moving from a large-group coverage plan offered at work.

Under a number of new options in the proposal, people who now have no choice when leaving a job but to extend insurance at work by paying the full premium cost could instead sign up for insurance at a third or half as much as a full premium but would have deductibles of $2,000 or $4,000. Each family member could receive up to a $300 deduction annually in outpatient care, whether in a doctor's office or emergency room before the deductible is assessed.

A wellness incentive is included that would allow a discount in premiums, a deductible reduction or provide virtual health-care dollars to offset health-care services.